Long Term Support Services (LTSS) Support Specialist

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 Long-Term Support Services (LTSS) Support Specialist is responsible for oversight of HCBS-Residential Care providers, Community Case Management Agencies (CCMA), and support other Home and Community Based Services (HCBS) efforts. Conducts quality oversight activities including case file audits and CCMA contract monitoring activities. Interacts with members, providers, and physicians to coordinate primary, acute, behavioral, and long-term services and supports (LTSS) for individuals having special health care needs. Interacts with members and their self-directed (SD) caregivers, assisting with electronic verification and validation (EVV) training and adherence, coordinating caregiver questions and concerns regarding pay for services. Job functions are performed in accordance with requirements of the QUEST Integration contract and health plan goals and quality outcome metrics.

Primary Duties & Responsibilities:

• Oversee the relationship with Community Care Foster Family Home (CCFFH) providers and Community Case Management Agencies (CCMA) to ensure compliance with contractual requirements and that members residing in HCBS Residential Care settings receive appropriate services.
• Carries the caseload of members delegated to CCMAs and ensures all assessment and service plan information in member’s records are accurate and current.
• Interact with CCFFH’s, CCMA’s, providers, and physician(s) to ensure appropriateness of services. Utilizing knowledge of LTSS and HCBS residential care, interacts with members and providers to determine and respond to appropriateness of service requests for health plan benefits and community resources.
• Interact with members, family, physicians, and other providers.
• Conduct in-person member assessments when CCFFH or CCMA requests for additional fees are requested.
• Apply MQD fee schedule to members' needs and make recommendations to provider requests.
• Conduct monthly multi-disciplinary rounds with Health Coordination, UM, Behavioral Health, Population Officer and Medical Directors on initial or revisions to CCFFH and/or CCMA agreements
• Outreach to CCFFHs and CCMAs for member placement and fee negotiation. Provides follow-up correspondence both telephonically and in writing.
• Coordinate with the Health Coordination and Medical Management team when member needs and acuity levels are not appropriate for CCFFH/CCMA referral or placement, and providers cannot be located.
• Ensure accuracy of electronic database records
• Facilitate access to services and service authorization.
• Monitor and resolve any concerns about service delivery or providers.
• Assist members in transitioning between hospital, nursing facility, CCFFH and other congregate settings to another community-based setting.
• Assist with completion of Self-Direction enrollment packet, assists with member and caregiver training/retraining of EVV system, monitors, and completes follow-up related to Self-Direction caregivers.
• Coordinate with members who have selected self-directed caregivers to provide their HCBS services to ensure understanding of requirements. Supports clarification of training and re-training and resolution of issues.
• Assist CCMA and CCFFH to connect members to additional social services available to them.

• Perform monthly CCMA monitoring activities and annual on-site CCMA reviews under the direction of Health Coordination Director or Manager.
• Conduct Care Plan or Health Action Plan reviews with members as required to monitor and document the progress of goals and services in their Care Plan or Health Action Plan.
• 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 with completion of eligibility forms required for Long Term Services and Supports (LTSS) services.
• Perform tasks that align with and support departmental and organizational objectives
• Perform periodic audit reviews of records as directed by the Health Coordination Director or Manager.
• Maintain accurate written documentation and records of coordination activities in computer systems according to appropriate service coordination and/or clinical guidelines.
• Ensure 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, 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 of care coordination responsibilities.
• Ability to patiently teach technology requirements and skills to caregivers who may have very limited device knowledge.
• 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.
• Intermediate skills in 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 a current valid Hawaii driver’s license and access to an insured automobile.
• TB Clearance
• First Aid and CPR Certification

Preferred Requirements:

• Associates degree or equivalent combination of education and experience.
• Experience serving LTSS members in the community.
• 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 LTSS members in the community.
• Previous experience in utilization management, discharge planning and/or home health or rehab.

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 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: $55,000 - $65,000 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.