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Care Coordination Director

Location:

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.

 

The Opportunity:

 

The Director of Care Coordination is responsible for carrying out the mission and goals of this business unit within Health Services, serving members in the MedQUEST and Medicare DSNP programs.  The Director’s objectives involve an integrated relationship with field-based clinical staff, striving toward outstanding care coordination.  The quality and financial goal of the Directors to ensure Low risk, SHCN and SHCN+ members have the appropriate level of Care Coordination intervention to decrease the potential of moving toward high health service utilization, poor quality outcomes, and escalating avoidable costs.  The Director’s goal is also to collaborate with internal and external Care Coordination teams to facilitate the movement of members from one care level to the next ensuring the appropriate level of services and care coordination intervention is provided in the least restrictive setting.  The Care Coordination Director aligns the department and internal or externally delegated Care Coordination Teams with AlohaCare’s mission, vision, values, and strategies.

 

The Director of Care Coordination also provides administrative oversight and monitoring of the Transition of Care Program (TOC) development and implementation. The Director of Care Coordination supervises the Manager of Care Coordination and Transition of Care as well as professional nursing staff and non-nursing staff performing transition of care functions ensuring that members receive care and services that meet all contractual and regulatory requirements for quality, timeliness and access. The quality and financial goal for the Director is to decrease Readmission and Emergency Department utilization for low level visits, preventing poor quality outcomes, and escalating avoidable cost.

 

Primary Duties, Responsibilities and Competencies: 

 

Operational

 

Direct operations to achieve department goals and objectives in satisfying or exceeding contractual obligations, accreditation standards, and service to members and providers

In conjunction with other health plans, MQD, PCMH, Hale Ola’ and providers, develop an enhanced referral process to support member’s access to appropriate services at the appropriate care level

Develop and implement appropriate processes to facilitate effective management of members’ medical and behavioral health services in ensuring services and care are appropriate

Monitor services provided for continuity, cost effectiveness, medical necessity, and timeliness in conjunction with AlohaCare’s Delegation Vendor Oversight Committee team members.

Monitor and update policies and procedures in conjunction with other departments and internal and external Care Coordination teams to ensure gaps in care are closed to decrease or avoid future acute episodes

Oversee and manage the budgetary and financial aspects of the Care Coordination and Transition of Care teams

Make business decisions that consider organizational policies and procedures, Business Conduct Guidelines, transparency and accountability, and financial or budgetary impact

Establish internal controls and feedback processes that enable rapid identification of significant trends or variances in operations and early responses and communicate trends to internal and external provider groups

Develop policies and procedures for monitoring and addressing SDoH needs in AlohaCare’s population

Prepare, maintain, and provide reports related to Care Coordination and Transition of Care activities for internal and external Care Coordination teams

Communicate operating performance to CQIC and, as requested, other individuals within AlohaCare

Support clinical training team to  execute continuous training and learning through different activities and venues for both Care Coordination Teams, Transition of Care Teams and providers

Participate actively in Executive Council meetings

Review performance data, including contractual and financials, routinely, for the purpose of monitoring productivity, timeliness of Care Coordination and Transition of Care activities  and goal achievement

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.

Collect TOC information and use it for performance improvement and QI activities/initiatives as required by the QI program.

Ensure adequate and timely document preparation and maintenance of Care Coordination and Transition of Care records which enables prompt response to regulatory agency audits and surveys and other internal and external request for data 

Participate in all contractual and regulatory audits involving internal and external Care Coordination teams, and lead the auditing department/staff in the audit preparations.

Participate in organizational workgroups or assigning Manager of Care Coordination or other departmental staff to participate as appropriate.

Ensure compliance with all state and federal regulations, including HIPAA stand standards of confidentially of protected health information, reporting critical incidents and reporting of quality of care issues.

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.

Other duties as assigned

 

Human Resources-Related

 

Work closely with Human Resources in planning, recruiting, choosing, hiring new staff, ensuring a formal on-boarding process

Oversee and direct internal and external Care Coordination teams in accordance with AlohaCare’s policies and procedures and emphasizing the importance of staff health and safety and whole person care

Monitor ratio of Care Coordination staff to members ensuring timely delivery of Care Coordination activities

Development Care Coordination Manager and staff through coaching, mentoring, training, individualized career plan, and providing opportunity for continuous development, retaining talented individuals

Delegate responsibility with its accountability to empower staff

Allow for disagreement and conflict, fostering the values of teamwork and resolution that enhances the staff and department to be successful

Train internal and external teams in self-management of performance to encourage growth, participation, and achievement

Recognize individual or group accomplishments

Address undesirable individual or group behaviors that require disciplinary action, collaborating with Human Resources

Monitor work schedules of on and off-site staff, based on rules of fairness, customer service, PTO, tele-commuting

Communicate with internal and external teams, continuously, through a variety of modes or venues, including regular team meetings and regular 1:1 meetings with Care Coordination Manager 

 

 Knowledge, Skills, Abilities and Competencies:

 

Unrestricted and current RN license in State of Hawaii, licensed social worker or experience with serving SHCN and SHCN+ beneficiaries

Bachelors or higher degree

5+ years of experience in working with SHCN or SHCN+ populations

Minimum of 5 years of experience in care coordination or case management within a medical or behavioral health setting

Minimum of 5 years of management experience

Excellent skills in organizing, communicating, team building, and time management

Demonstrated ability to partner with multiple stakeholders, such as care team, primary care provider, behavioral health clinician, health service administrators, external parties

Experiences that indicate abilities in problem solving and decision-making

Proficiency in common software systems such as Microsoft Suite.

 

 

Physical Demands/Working Conditions:

 

May require prolonged sitting - up to 4 hours; occasional lifting, up to 20 pounds.

Travel required to provider and clinical locations

Requires operation of a computer workstation, including keyboard and video display terminal.

 

Additional Job Requirements:  

 

Business hours are Monday through Friday 8:00 a.m. to 5:00 p.m.  At times, may need to work earlier or later depending upon the needs of the situation.

 

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.

Contact Information

Contact: Josie Gesteuyala, AlohaCare
Email: jgesteuyala@alohacare.org
Phone: 808-973-6339

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