Health Coordinator, RN or SW

Job Description

Job Description

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The Company:

AlohaCare 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.

The Culture:

AlohaCare 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.

AlohaCare’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.

AlohaCare’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.

The Opportunity:

The Health Coordinator is responsible for conducting face-to-face assessments, developing individualized health action plans, interacting with members, providers, and physicians to coordinate primary, acute, behavioral, and long-term services and support (LTSS) for individuals having special health care needs. Job functions are performed in accordance with the requirements of the QUEST Integration contract and health plan goals and quality outcome metrics.

Primary Duties and Responsibilities:

• Conducts face-to-face or virtual (video chat) Health and Functional Assessments (HFA) for all Special Health Care Needs, Expanded Health Care Needs, Long-Term Services and Supports, Community Integration Service Needs, or Community Care Service Needs members on an annual or more frequent basis (as applicable) and a Level of Care Assessment (DHS Form 1147) for members needing long term care.
• Engages member/providers to participate in the assessment process and collaboratively develop a person-centered Health Action Plan for each member, based upon the HFA, DHS-1147, or other assessments.
• Ensures the Health Action Plan is a person-centered individualized plan that is developed with the Member and/or authorized representative, is based on an assessment and developed within no more than 30 calendar days of completion of the assessment.
• Interacts with members, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to determine the member’s current status and capacity and to assess the options for service delivery including use of health plan benefits and community resources to update a Member’s Health Action Plan.
• Meets with members at a minimum every 90 days in-person or via video chat to monitor and document the Member’s progress of goals and services in the Health Action Plan.
• Screens for social risk factors and incorporate information on the results of positive screens into clinical decision making and offer screened members interventions to mitigate the impact of social risk factors, including timely referrals with positive screens.
• Assists the members with connection to social services to help find and apply for housing necessary to support the individual in meeting their medical care needs.
• Facilitates authorization and access to services.
• Verifies authorized or coordinated services have been provided.
• Monitors and resolves any concerns about delivery of service or providers and ensures that the services being provided meet the members’ needs.
• Surveys members to ensure member satisfaction with providers and services.
• Provides individualized education on preventative health care measures.
• Provides information on HCBS alternatives to nursing facility placement and the choice of Self-Direction of HCBS.
• Monitors and performs health coordination activities for members in Self-Direction program.
• Monitors the Electronic Visit Verification portal for completed visits including completion of time sheets when needed.
• Ensures members complete annual primary care visits, routine and preventative screenings, and other care gaps related to quality initiatives.
• Assists members in transitioning between hospital, nursing facility, other congregate settings and other community-based locations ensuring a seamless and continuous coordination of care across a continuum of care.
• Refers to and works with Hawaii CARES to ensure Members receive, SUD, mental health, and co-occurring treatment and recovery support services, as well as crisis intervention and support services in a timely manner.
• Connect members with Social Determinates of Health (SDoH) needs with any Community Resources in their neighborhood or area or utilizing the Unite Us tool.
• Coordinates care with members receiving services through AMHD, CAMHD and DDD programs.
• Meets operational and compliance with due dates for assessments, care plans, and all regulatory required activities.
• Perform tasks that align with and support departmental and organizational objectives.
• Maintains accurate written documentation and records of health coordination activities in case management systems according to appropriate service coordination and/or clinical guidelines.
• Ensures compliance with all state and federal regulations, including HIPAA standards of confidentiality of protected health information, reporting critical incidents and reporting of quality-of-care issues.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, and 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.

Requirements:

• Associate’s, Bachelor’s, or Master’s degree in Health Care Administration, Nursing, Social Work, Public Health, or related field or equivalent combination of education and experience.

• Licensed RN, LPN, LBSW, LSW, LCSW, LMHC, LMFT or CSAC in the State of Hawaii.
• Licensed LBSW must practice under appropriate supervision in accordance with Hawaii Revised Statues
• Experience with serving members in the community.
• Health plan experience with care coordination responsibilities.
• Experience with Medicare / Medicaid programs.

• Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, and individuals with physical disabilities.
• Prior nursing home diversion or long-term care case management experience serving members in the community.
• Previous experience in utilization management, discharge planning and/or home health or rehab.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Ability to solve problems, analyze, think critically and make good judgment.
• Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Able to work independently with minimal supervision.
• 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.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
• Possession of valid driver’s license with access to a reliable insured automobile.

• TB Clearance
• First Aid and CPR Certification

Preferred Requirements:

• Bi-lingual in any of the following languages preferred: Ilocano, Tagalog, Mandarin Chinese, Japanese or Korean.
• Ability to communicate using American Sign Language.

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to 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.
• Field working environment.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday. ?

Salary Range: $80,000 - $85,000 annually

AlohaCare 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.