Job Description

Job Description

Job Description

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii .

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through 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 through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

Position Summary:

The primary role of the Care Coordinator is to coordinate member services as outlined in the individualized health action plan under the direction and in collaboration with the member’s Health Coordinator. The Care Coordinator will include other follow up or issue resolution as it relates to the member’s health action plan or care. The Care Coordinator will also complete regular reviews of the individual health action plan with the member as required by the RFP. The work can be completed telephonically, in the community (field) and/or at the Care Coordinator’s office.

Primary Job Duties and Responsibilities:

• Implement individualized Health Action Plan
• Meets with the member at a minimum of every 90 days in person or via video chat to monitor and document the Member’s progress in the Health Action Plan.
• Conducts face-to-face or virtual (video chat) to complete regular reviews of the individual health action plan at least every 90 days.
• Engages member/providers to participate in the review of a person-centered Health Action Plan for each member, based upon the HFA and other assessment.
• Identifies and resolve barriers throughout the continuum of HAP goals, and reports variances to appropriate care team members towards a working solution.
• Interacts with member, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to assist in determining 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.
• Conduct initial post discharge follow up for members engaged in Health Coordination.
• Initiate enrollment into other program benefits based on eligibility.
• Conduct issue resolution related to the goals of the Health Action Plan or other program benefits.
• 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 member to Community Resources in their neighborhood or area.
• Assist Care Team with coordination of appointments for members.
• Provides individual member education on preventative health care measures and on medication education and adherence to meet health action plan goals.
• 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 member’s 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).
• Manage and meet periods for completing scheduled and assigned daily activities on the activity log within the Care Management system Document completed activities and other notes in the Care Management system
• Assist the member (when needed) 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.
• Generate and create reports as needed.
• Participate in Health Coordination staff meetings, interdisciplinary care team meetings, Behavioral Health Rounds and Inpatient Rounds meetings as required.
• Other duties as assigned by supervisor and/or manager
• Responsible to maintain 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

Required Competencies & Qualifications:

• High School Diploma

• Minimum one (1) year 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

• Strong verbal and written communication in English.

• Requires operation of general office equipment to include PC, Surface Pro 3, fax/copy machine and company phone. Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.

• Possession of a valid driver’s license and auto insurance with access to a reliable, 4-wheel, safety- inspected vehicle.

• TB Clearance

• First Aid and CPR Certification

Preferred Competencies & Qualifications:

• Bachelor’s degree in human services, Sociology, Psychology, or other related field.

• Bilingual in Ilocano, Tagalog and/or Korean preferred

• 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’s degree or previous equivalent healthcare experience preferred

• Three (3) years of Care Coordination, outreach and customer experience

Physical Demands/Working Conditions:

• Medium work: Walking, standing and exerting up to 40 pounds of force occasionally, or up to 25 pounds of force frequently, or greater than negligible up to 10 pounds of force constantly to move objects.
• May require prolonged sitting up to 4 hours.
• Requires operation of a computer workstation, including keyboard and video display terminal.

Salary Range: $24.00 - $30.00 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/veterans’ status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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