Insurance Case Manager Jobs in Hawaii (NOW HIRING)

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 Care Management Supervisor Supervises the case management team and the care coordination of behavioral health members to promote quality and efficacy of care management delivery related to mental and behavioral health needs. Supervises day-to-day escalations and care management issues related to members or providers.?

Additionally, the Case Management Supervisor will assist with the provision of or reinforcement of training principles for other team members. Key success factors for this role include acting as a SME in teamwork and team building, assisting and encouraging the teams productivity, unity and flexibility. 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:

• Monitor and review care management required documentation to maintain compliance with federal and state regulations and contractual agreements.
• Assign caseloads to care management staff based on state requirements, care management staff experience, and member needs.
• Works with senior management on escalated and complex care cases related to BH and provides guidance to junior team members to address member concerns.
• Educates and provides resources for care management team on key initiatives and member outreach.
• Evaluates care management team performance and provides feedback regarding performance, goals, and career milestones
• Provide coaching and guidance to care management team and providers to ensure members are receiving high quality care and information regarding service / care plan options, procedures, referrals, and healthcare benefits.
• Upon notification of a crisis the CM, and CM supervisor, as necessary, shall triage and employ necessary interventions to assist member recover from the crisis. If imminent danger is suspected or present activates emergency services, as necessary and consistent with training and policy.
• Monitors and review reports on a regular basis ensuring quality and productivity metrics are met and for case assignments and may perform audits of staff on a regular basis.
• Assists with onboarding, hiring, and training care management team members.
• Participates in workflow design/redesign and provides recommendation for improvements.
• Assists in reinforcing training principles.
• Gives constructive feedback to their direct reports to improve efficacy, efficiency and effectiveness of interventions and workload management.
• Provides professional, open and honest communication, courtesy and respect between supervisor/manager, and members of their team.
• Provides candid peer-review feedback to leadership team or others as requested to support performance reviews, identifying and offering suggestions on opportunities for improvement
• Identifies concerns and discusses actions with staff and managers to ensure issues are addressed
• Ability to resolve conflict with courtesy and respect

• Perform tasks that align with and support departmental and organizational objectives
• Maintains accurate written documentation and records of case management activities in computer systems 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 critical incidents and reporting of quality-of-care issues.
• 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, 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.

Requirements:

• Associates degree in health care administration, Nursing, Long Term Services and Supports, Public Health, or related field or equivalent combination of education and experience.

• Minimum of 4 years of experience in related field.
• Minimum of 1 year of experience leading/managing and developing a team.
• Experience with serving members in the community.
• Health plan experience with case management responsibilities.
• Experience with Medicare / Medicaid programs.

• Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, individuals with physical disabilities, housing insecurity, mental health and substance use disorder and other vulnerable needs.
• Previous experience in utilization management, discharge planning and/or housing resources.

• 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 interpersonal, facilitation and leadership skills with 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 judgment and make 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; is 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.
• TB Clearance
• CPR Certification

Preferred Requirements:

• Licensed RN with BH experience, LPN, LCSW, LSW, LMHC, LMFT or CSAC in the State of Hawaii
• Bi-lingual in any of the following languages preferred: Ilocano, Tagalog, Mandarin Chinese, Japanese or Korean
• Ability to communicate using American Sign Language

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 to 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 office work environment.
• Work evenings and weekends as needed as the need for services arises.
• Possible interstate travel with occasional overnight stay.
• 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.