Care Coordinator

The Care Coordinator supports care management activities and the teams assigned to members to ensure services are delivered by 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. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time‑off, 401k employer contribution, referral bonus and pre‑tax transportation and parking program. 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. Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care. Supports performing service assessments/screenings for members with some complex needs and documents the member’s care needs. Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed. Works 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. Has the ability to identify needs and make referrals to Care Manager, community case organizations, and Disease Manager. Follows up with 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. Prepares and coordinates letters/correspondences to members, PCPs, and providers as requested by the Clinicians/ Supervisor/Manager. Assists the Supervisor/Manager in generating and monitoring utilization (UM) reports, BH reports, member service reports, HEDIS, QI reports, and claims resolutions. Participates in staff meetings and training, takes minutes/attendance, and posts on BH Share Point. Assists in the maintenance of Program-related materials received from providers, as well as educational materials. Assists the department with claims review and/or denial reconciliation when requested. Provides education on benefits and resources available. May assist with training and development needs. 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. Minimum of 1 year of experience in related field. Experience working in behavioral health care or care coordination. Understanding of the concepts of care coordination within the managed care field. Achieves results, builds trust, communicates effectively, customer and quality focused. Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization. Can work independently with minimal supervision. Can 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. 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. 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. #J-18808-Ljbffr AlohaCare