Transitions of Care (TOC) Supervisor, RN, LCSW or LSW

Job Description

Job Description:\n\nApply online at Company:\n\nAlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors, and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.\n\nThe Culture:\n\nAlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.\n\nAlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.\n\nAlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.\n\nThe Opportunity:\n\nThe Transition of Care (TOC) Supervisor leads and supports the TOC team in coordinating safe, timely, and effective transitions for members discharged from inpatient settings back to the community. This role helps ensure members receive the support, education, referrals, and follow-up needed to reduce avoidable readmissions, improve post-discharge outcomes, and promote continuity of care.\n\nThe TOC Supervisor works under the direction of the Health Coordination Director, alongside the Health Coordination Managers, and is responsible for supervising day-to-day team activities, coaching staff, reinforcing workflows, monitoring productivity, supporting audit readiness, and serving as a subject matter expert for TOC processes. The role supports the TOC Program’s focus on safe, cost-effective, high-quality care after hospitalization and contributes to quality and value-based outcomes such as reduced 30-day readmissions, improved emergency department utilization, and improved care coordination for members with chronic conditions, behavioral health needs, and social determinants of health needs.\n\nThe TOC Supervisor collaborates with internal teams such as Health Coordination, Medical Management, Behavioral Health, and Quality, as well as external providers, community resources, members and their families and caregivers to support successful care transitions. The role requires strong leadership, communication, organization, critical thinking, and the ability to support staff performance while maintaining compliance with QUEST Integration, Medicare, CMS Model of Care, NCQA, contractual, regulatory, and quality requirements.\n\nPrimary Duties & Responsibilities:\n\nTransition of Care Program Supervision\n\n Supervises the TOC team and supports day-to-day operations of the Transitions of Care Program.\n Supports implementation of TOC workflows aligned with QUEST Integration, CMS Model of Care, NCQA Care Transitions requirements, and organizational goals.\n Provides guidance, coaching, mentoring, and training to TOC staff to support consistent, effective, and timely member outreach.\n Serves as a TOC subject matter expert for staff, internal departments, providers, and community partners.\n Assists the Health Coordination Director with workflow design, workflow redesign, staff education, performance monitoring, and process improvement.\n Reinforces team productivity, accountability, unity, flexibility, and adherence to established workflows.\n Supports the team in helping members understand discharge instructions, follow-up appointments, medications, next steps in care, warning signs, and available health plan or community resources.\n Promotes timely post-discharge outreach and care coordination for members transitioning from inpatient facilities, nursing facilities, other congregate settings, and community-based locations.\n Supports member transitions back to the community by helping ensure care is coordinated across providers, facilities, internal teams, and community supports.\n Helps identify barriers that may increase readmission risk, including chronic conditions, behavioral health needs, psychosocial concerns, home environment concerns, access barriers, and social determinants of health needs.\n\nMember Transition and Readmission Reduction\n\n Oversees TOC activities that support safe discharge from inpatient care back to the community.\n Ensures members receive timely follow-up support during the post-discharge transition period.\n Supports staff in reviewing discharge information and identifying needed referrals, services, authorizations, care coordination activities, and member education.\n Collaborates with clinical managers and appropriate internal teams to support individualized care planning when needed.\n Assists with ensuring members receive medically necessary, timely, appropriate, and cost-effective services during the post-transition period.\n Supports efforts to reduce avoidable hospital readmissions and improve member outcomes after discharge.\n Monitors trends related to readmissions, emergency department utilization, quality measures, and other program performance indicators as directed by the Health Coordination Director.\n Supports value-based care and quality outcomes through effective TOC coordination, member engagement, and escalation of identified barriers or concerns.\n\nStaff Leadership, Coaching, and Performance Support\n\n Provides direct supervision, coaching, mentoring, and constructive feedback to TOC staff.\n Assists with orientation and training of new TOC staff and reinforces department training principles.\n Supports staff development through case consultation, workflow review, documentation feedback, and identification of learning needs.\n Helps staff manage priorities, workload, member engagement needs, documentation requirements, and follow-up expectations.\n Identifies staff concerns or performance barriers and discusses appropriate actions with the Health Coordination Director.\n Promotes professional, open, honest, courteous, and respectful communication between team members, supervisors, managers, members, and internal partners.\n Supports conflict resolution with courtesy, professionalism, and respect.\n Assists with staff scheduling, coverage planning, PTO coordination, and operational continuity as delegated by the Health Coordination Director.\n May provide input to leadership to support performance reviews, training needs, and opportunities for improvement.\n\nReporting, Audits, Compliance, and Quality Improvement\n\n Participates in development, maintenance, and monitoring of operational reports related to TOC activities.\n Monitors and reports utilization of Going Home Plus (GHP) and Community Integration Services Plus (CIS+).\n Conducts internal audits and reports findings to support quality, compliance, and performance improvement.\n Assists with preparation for regulatory, contractual, accreditation, internal, and external audits.\n Supports timely review, preparation, and maintenance of documentation needed for audits, surveys, and data requests.\n Participates in quality improvement activities to ensure members receive timely, appropriate, high-quality care and services.\n Identifies and escalates quality-of-care concerns, critical incidents, sentinel events, or other concerns according to policy.\n Helps monitor departmental performance measures, standards, and outcomes.\n Supports corrective action plans and process improvement efforts when needed.\n Maintains awareness of key requirements related to regulatory contracts, accreditation standards, business operations, and department goals.\n Ensures compliance with all state and federal regulations, including HIPAA standards of confidentiality, protected health information requirements, quality-of-care issue reporting, and AlohaCare policies and procedures.\n\nCollaboration and Communication\n\n Collaborates with the Health Coordination Director, Health Coordination Managers, clinical operations, Medical Directors, Behavioral Health, Quality, providers, facilities, community resources, members, family members, and caregivers.\n Supports communication between inpatient facilities, outpatient providers, health plan teams, and community-based services to promote seamless transitions of care.\n Participates in department meetings, staff huddles, work groups, and cross-functional initiatives as assigned.\n Assists with presentations or department updates related to TOC workflows, outcomes, process changes, or audit readiness.\n Identifies interdepartmental dependencies and communicates barriers, risks, and opportunities for improvement to the Health Coordination Director.\n All other duties assigned.\n Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.\n Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.\n\nRequirements: \n\n Associate’s degree in health care administration, Nursing, Social Work, Long Term Care Services, Public Health, or related field or equivalent combination of education and experience.\n\n Licensed RN, LCSW or LSW in the State of Hawaii.\n Minimum of 3 years of experience in a health plan or clinical setting and/or managed care environment.\n Minimum of 1 year of experience managing and developing a team.\n Prior experience in clinical assessment, discharge planning, and utilization management.\n Achieves results, builds trust, communicate effectively, customer and quality focused.\n Excellent interpersonal skills with the ability to communicate with all levels of the organization.\n Strong interpersonal, facilitation, and leadership skills with the ability to interact with various departments/ project teams.\n Excellent, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.\n Ability to organize, coordinate, and supervise large projects in a timely, creative, and effective manner.\n Ability to solve problems, analyze, think critically, make good judgments, and make fair decisions.\n Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.\n Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.\n Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.\n Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.\n Excellent leadership, communication, and analytical skills.\n Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.\n Intermediate skills in Microsoft Programs: Word, Excel, Outlook, and PowerPoint.\n Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.\n\nPreferred Requirements:\n\n Minimum of 2 years of inpatient clinical experience.\n Bachelor’s degree in health care administration, Nursing, Social Work, Long Term Care Services, Public Health, or related field or equivalent combination of education and experience.\n Experience with QUEST and Medicare DSNP Programs and working knowledge of managed health care fields.\n Experience with individuals who are low-income or have special health care needs, including HIV/AIDS, BH/SUD, developmental disabilities, medical-fragile, older adults, and individuals with physical disabilities.\n\nMental, Physical and Environmental Demands: \n\n Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.\n In office working environment.\n May require prolonged sitting- up to 4 hours.\n Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday. \n\nSalary Range: $95,000 - $105,000\nAlohaCare is committed to providing equal employment opportunities to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.