Behavioral Health Utilization Management Jobs in Hawaii

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

The Company:

AlohaCare is a local, non-profit health plan serving Hawai`is low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors, and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaiis third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.

The Culture:

AlohaCare employees have a passion for helping Hawai`is most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.

AlohaCares leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

AlohaCares comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Opportunity:

The Behavioral Health Case Management Liaison manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Acts as provider liaison to oversee the Community Based Case Management (CBCM) Agencies who deliver and coordinate the behavioral services of the CCS contract. Monitors CCS contract compliance with the CBCM Agencies by collecting clinical data and maintaining accurate records for tracking and metric purposes.

Primary Duties and Responsibilities:

• Manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability.
• Acts as provider liaison to oversee the Community Based Case Management (CBCM) Agencies who deliver and coordinate the behavioral services of the CCS contract.
• Identification and tracking of all assigned members of assigned CBCM agencies.
• Audits member records for compliance of CCS contract.
• Collects clinical data and maintains accurate records for tracking and metric purposes.
• Oversees CCS contract compliance of the CBCM agencies (i.e. Behavioral Health Assessment (BHA)/Individualized Treatment Plan (ITP) received within specified timeframes, quarterly BHS reports, post hospitalization follow-up, etc.) including onsite trainings and audits.
• Maintains ongoing contact with assigned CBCM agencies. Participates in agency educational meetings and agency visits.
• Facilitates enrollment and eligibility changes.
• Monitors and oversee the HSH provisional enrollment process
• Notifies CBCM Agency when a member is admitted for a Behavioral Health Inpatient Hospitalization.
• Reviews authorization requests for CCS program benefits.
• Serves as Officer of the Day (OOD) to address calls from customer service and internal Ohana staff.
• Processes Adverse Events.
• Coordinates with members QUEST Integration Health Plan Service Coordinator for continuity of care.
• Holds Interdisciplinary Team (IDT) Meetings for complex, high-risk, high-utilizing members and participates in departmental clinical rounds.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining AlohaCares 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.

Requirements:

• Bachelors degree with emphasis in social work, Psychology, Counseling, Nursing, or related field or equivalent combination of education and experience.
• Minimum of 2 years of experience in behavioral health management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization, case management and discharge planning.
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Excellent interpersonal skills with the ability to communicate with all levels of the organization.
• Strong facilitation, and leadership skills with the ability to interact with various departments/ project teams.
• Excellent, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Ability to organize, coordinate, and supervise large projects in a timely, creative, and effective manner.
• Ability to solve problems, analyze, think critically, make good judgments and fair decisions.
• Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.
• Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.
• Able to 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.
• Demonstrated strong skills in providing solutions and/or trouble shooting complex issues.
• Excellent leadership, communication, and analytical skills.
• Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Intermediate skills in Microsoft Programs: Word, Excel, Outlook, and PowerPoint.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
• Possession of a current valid Hawaii drivers license and access to an insured automobile.

Preferred Requirements:

• Licensed RN, LCSW, LMHC, LMFT, APRN, or Licensed Psychologist in the State of Hawaii.
• Experience in a managed care environment.

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• In an office working environment.
• Ability to travel interstate with occasional overnight stay.
• Work evenings and weekends as needed as the need for services arises.
• 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.

Salary Range: $70,000 - $83,000 annually

AlohaCare is committed to providing equal employment opportunities 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/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.