Care Coordinator

Care Coordinator

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 Care Coordinator supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Serves as a liaison alongside care managers and providers to ensure proper coordination of care for members and interacts with members by performing member outreach telephonically or through home-visits.

Primary Duties and Responsibilities:

• Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate.
• Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed.
• Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plans.
• Develops in-depth knowledge of care management services including responding to some complex or escalated issues.
• Communicate with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care.
• Support performing service assessments/screenings for members with some complex needs and documents the member's care needs.
• Support documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed.
• Work with care management team triaging, adjusting, and escalating complex requests to management.
• Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards.
• Ability to identify needs and make referrals to Care Manager, community case organizations, and Disease Manager.
• Follow up with the members who no longer meet the criteria for additional and intensive behavioral health services from the CCS program, and who are transitioned back to the base plan for BH services.
• Prepare and coordinate letters/correspondences to members, PCPs, and providers as requested by the Clinicians/ Supervisor/Manager.
• Assist the Supervisor/Manager in generating and monitoring utilization (UM) reports, BH reports, member service reports, HEDIS, QI reports, and claims resolutions.
• Participate in staff meetings and training, take minutes/attendance, and post on BH Share Point.
• Assist in the maintenance of Program related materials received from providers, as well as educational materials.
• Assist the department with claims review and or denial reconciliation when requested.
• Provide education on benefits and resources available.
• May assist with training and development needs.
• Comply with all policies and standards.
• 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, 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:

• High school diploma or equivalent
• Minimum of 1 year of experience in related field.
• Experience working in behavioral health care or care coordination.
• Understanding the concepts of care coordination within the managed care field.
• 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.
• Professional telephonic etiquette skills.
• Ability to solve problems, analyze, think critically, and make good judgments.
• 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; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Data entry experience with a high degree of accuracy and attention to detail.
• 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:

• Associate's degree in health service Field or related field or equivalent combination of education and experience.
• Minimum of 2 years of work experience as a case manager in a community setting.
• Knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient community resources.

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 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.
• In an office 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: $16.50 - $22.00 an hour

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.