Apply on line at http://www.alohacare.org/Careers/Default.aspx
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.
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 Service Coordinator is responsible for conducting face-to-face assessments, developing individualized service plans, interacting with members, providers, and physicians to coordinate primary, acute, behavioral, and long term services and supports (LTSS) for individuals having special health care needs. 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:
Conducts face-to-face Health and Functional Assessments (HFA) for all members on an annual or more frequent basis (as applicable) and/or a Level of Care Assessment (DHS Form 1147) for member needing long term care
Engages member/providers to participate in the assessment process and collaboratively develop a Service Plan for each member, based upon the HFA, DHS-1147, or other forms.
Interacts with member, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to determine 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 Service Plan.
Coordinates member access to community resources with other sources of care, Primary Care Physicians, specialists, family members, and other health providers, with emphasis on the development of natural support system in coordination with health plan benefits and other public programs.
Facilitates member choice.
Facilitates member and provider authorization and access to services.
Monitors and resolves any concerns about service delivery or providers and to ensure that the services being provided are meeting the member’s needs.
Provides individualized education on preventative health care measures and HCBS alternatives to nursing facility placement.
Monitors and performs service coordination activities for members in self-direction program.
Assists members in transitioning between hospital, nursing facility, other congregate settings and other community-based locations.
Refers members with suspected severe emotional, behavioral and/or mental illness for evaluation and treatment.
Maintains accurate written documentation and records of service coordination activities in computer system according to appropriate service coordination and/or clinical guidelines.
Ensures compliance with all state and federal regulations, including HIPAA standards of confidentiality of protected health information, reporting of critical incidents and reporting of quality of care issues.
Performs 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 and Qualifications:
Experience with serving members in the community
Health plan experience with care coordination responsibilities
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 members in the community
Previous experience in utilization management, discharge planning and/or home health or rehab
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
Possession of valid driver’s license with access to a reliable insured automobile
Associate’s degree in Health Care Administration, Nursing, Long Term Services and Supports, Public Health, or related field
Licensed RN or LPN in the State of Hawaii
Bi-lingual in any of the following languages preferred: llocano, Tagalog, Mandarin Chinese, Japanese or Korean
Ability to communicate using American Sign Language
Physical Demands/Work Environment:
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.