Community Health Worker

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 primary role of the Community Health Worker is to engage and build relationships with members and providers to improve health outcomes. Community Health Workers will educate and assist actively enrolled AlohaCare members on how to navigate their health plan benefits. The Community Health Worker participates in completion of assessments; care plans; gap closures; and community referrals for our members. The majority of the Community Health Worker’s time may be spent in the field or a community/facility setting conducting face-to-face or home visits or members events with AlohaCare members; locating members in the community who have been unengaged with the health plan; accompanying members to provider appointments; and coordinating member services under the direction of, or in collaboration with, the member’s Lead Care Manager or under clinical supervision in the field, hospital or community health center.

Primary Duties and Responsibilities:

• Perform initial outreach to conduct education and welcome call as needed.
• Engage members and providers in the assessment process.
• Conduct appropriate assessments timely via face-to-face or virtual (video chat for members identified as Special Health Care Needs (SHCN) or Rising Risk. Assessments include but are not limited to Health Risk Assessments (HRA) and Health Functional Assessments (HFA) and post discharge and readmission risk assessments.
• Collaborate with members, caregivers, and providers to develop a person-centered care plan for each member, based upon findings from the assessments. The plan of care for a SHCN member is known as the Health Action Plan (HAP) and can be facilitated by the CHW.
• Implement Care Plan or Health Action Plan for actively engaged SHCN or Rising Risk members by executing planned intervention(s) as directed, which include but are not limited to facilitating timely access to services, addressing barriers to care and medications, identifying and providing transportation assistance, if needed, etc., on behalf of the member and provider.
• Conduct issue resolution related to the goals of the Health Action Plan or other program benefits. Support member redetermination efforts and initiate enrollment into other program benefits based on eligibility.
• Conduct Care Plan or Health Action Plan reviews with members as required to monitor and document the Member’s progress of goals and services in their Care Plan or Health Action Plan.
• Assist with completion of eligibility forms required for Long Term Services and Supports (LTSS) services.
• Members may or may not be assigned directly to the Community Health Worker as the Lead Care Manager. The CHW works in conjunction with a Health Coordinator to meet the needs of members when necessary.
• Meet operational and compliant due dates for assessments, care plans, and all regulatory required activities.
• Under clinical supervision, when required, the CHW interacts with members, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to assist in determining the member’s 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.
• Conduct initial post discharge follow up for members engaged in Health Coordination.
• Collaborate onsite at Community Health Centers and other provider offices to support their AlohaCare patients with care coordination needs to improve health outcomes.
• Assist with locating Unable to Reach (UTR) members to include driving to the last known address and talking to providers in the community, community resources and/or shelters to locate members.
• Assist with delivering Durable Medical Equipment or prescriptions as needed.
• Assist members in completing forms/applications and other necessary documentation for other programs that can assist the member.
• Connect members with Social Determinates of Health (SDoH) needs with any Community Resources in their neighborhood or area or utilizing the Unite Us tool.
• Assist the Care Team with coordination of appointments for members.
• Assist the member in maintaining eligibility and connections with other entitlement programs the member may qualify.
• Coordinate with AlohaCare Health Coordination staff, and appropriate operational departments/units, as required by the members’ needs (e.g., Utilization Management, Transition of Care, Disease Management, Service Coordination, Travel, etc.), and network physicians/providers to ensure specialty services are in place (when applicable).
• Promote positive health outcomes by ensuring members receive comprehensive annual physical and preventive services.
• Complete scheduled and assigned daily activities on the activity log within the Health Edge Guiding Care Management system. Document Service Navigation activities in the Health Edge Guiding Care Management system.
• Assist the members with translation services and enabling services and coordination of medical benefits, including providing coordination assistance with other Medicaid QI Health Plans.
• Perform member outreach calls in collaboration with Quality Improvement projects, and Care Coordination activities related to Medicare HEDIS and STAR Ratings.
• Perform tasks that align with and support departmental and organizational objectives
• Generate and create reports as needed.
• 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 one 1 year of Member Outreach, Care Coordination, Managed Care, Health Care and or previous Health Plan with direct member support experience.
• Experience with serving members in the community.
• Health plan experience with care coordination responsibilities.
• 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 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.
• Intermediate skills in Microsoft Programs: Word, Excel or Access Databases, Outlook and PowerPoint.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
• Possession of a current valid Hawaii driver’s license and access to an insured automobile.
• TB Clearance.
• First Aid and CPR Certification

Preferred Requirements:

• Bachelor’s Degree in Human Services, Sociology, Psychology, or related field or equivalent combination of education and experience.
• Minimum of 3 years of Care Coordination, outreach, and customer experience
• Bilingual in Ilocano, Tagalog and/or Korean.
• Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, and individuals with physical disabilities.
• Ability to complete multiple tasks to ensure timeliness standards are met.
• Associate degree or previous equivalent healthcare experience preferred.

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 $28.00 - $32.00 an hour

AlohaCare is committed to providing equal employment opportunity 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.