Health Coordination Manager

Location:

Apply on line at http://www.alohacare.org/Careers/Default.aspx

 

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:


Job Summary:

 

Responsible for island oversight of staff performing service coordination functions to health plan members identified as having Special Health Care Needs (SHCN) or receiving Long Term Service and Support programs. Manages staff and processes to meet contractual performance standards, health plan goals and quality outcome metrics.  Job functions are performed in accordance with requirements of the QUEST Integration contract and health plan goals and quality outcome metrics.

 

 

 

 

Primary Duties and Responsibilities:

 

Manages health coordination staff responsible for coordinating primary, acute, and Long Term Services and Supports for those members that have been identified as having Special Health Care Needs.

Performs supervisory functions including interviewing, hiring, training, mentoring, conducting performance evaluations, and terminating employees in collaboration with Human Resource staff and Clinical Operations leadership.  Ensures service coordination staff meets required educational and/or licensing credentials and applicable training guidelines.

Collaborates in establishing, monitoring, implementing and evaluating AlohaCare’s Health Coordination program.   Includes updating and maintaining all policies and procedures.

Provides oversight of field-based service coordination operations to ensure compliance with all required health coordination activities, established timeframes, and mandatory reports.

Accountable for accurate and timely completion of all required reports, in collaboration with internal departments within AlohaCare.

Implements the strategic goals of AlohaCare’s QUEST Integration program, translating them into specific, measurable, operating and business plans.

Works with Quality Improvement and Medical Directors to develop and implement metrics that identify and mitigate barriers to improve member’s health care outcomes and goals for independence.

Creates and conducts provider outreach initiatives, and/or training in conjunction with AlohaCare’s Provider Relations Department.

Develops and maintains strong relationships within the community including State and Federal leaders, providers, vendors, business partners and community alliances.

Participates in service coordination staff meetings, interdisciplinary care team meetings and staff manager meetings as required.

Coaches health coordination staff and fosters a culture of leadership development.

Participates in annual budget development and ongoing monitoring of performance in relation to budgeted goals.

Attends QUEST Integration meetings as required.

Perform duties of departmental leads during absences or vacancies.

Other duties as assigned.

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:

 

Observed leadership competency with 3+ years of supervisory experience in a health related field.

Experience with implementing operational plans to achieve organizational goals.

Experience with QExA, QUEST and Medicare programs and working knowledge of managed health care field

Experience with individuals who are low-income or have special health care needs, including:  HIV/AIDS, developmental disabilities, medically-fragile, older adults, and individuals with physical disabilities.

Prior nursing home or experience serving LTSS members in the community.

Ability to solve problems and make decisions independently.

Ability to work in high stress environment at times, with pressure of multiple deadlines with varying priorities.

Ability to deal with potentially volatile providers, members, and family members, and to support AlohaCare’s corporate core values in all interactions.

Strong knowledge of community resources including: specialty care, behavioral health care resources, inpatient and outpatient and LTSS community resources.

Intermediate computer skills and experience with Microsoft Office products.

Must be organized and detail-oriented.

Must possess strong written and verbal communication and presentation skills and be able to communicate clearly (verbally and in writing) across departments and providers to facilitate action plans.

Possession of valid driver's license with access to a reliable automobile.

 

Required Qualifications

Bachelor’s Degree. Preferably in health care administration, nursing, public health or long term services and supports field.

3-5 years related work experience        

Licensed RN, LPN, LSW, LCSW or LBSW in State of Hawaii

CPR and Basic First Aid certified

2-Step Tuberculin Skin certified

Requires use of personal mobile device (Andriod or Iphones manufactured in the last 4 years) compatible with our application and email systems


Preferred Qualifications

Certification as Case Manager through a URAC-approved entity

Measurable success with operational performance and staff development.

Master’s Degree in Social Work, Health Care Administration, Long Term Services and Supports, Public Health, or related field

Multilingual preferred

 

Mental, Physical and Environmental Demands:

 

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

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.

 

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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University of Hawai‘i Alumni