Full-Time Care Coordinator, RN -SNP Medicare
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Job Description
The Company
AlohaCare is a local, non-profit health plan which provides comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. In the true spirit of Aloha, AlohaCare supports, cares and serves the health care needs of Hawaii’s residents and specializes in care for the medically underserved and medically fragile. 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’s strong commitment to support local Hawaiian families is practiced with our employees by reinforcing a healthy work/home balance. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, monthly appreciation events, quarterly all-staff meetings and annual galas. 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 – Position Summary
The SNP MOC Care Coordinator is responsible for completing an array of comprehensive medical and psychosocial assessments, developing individualized care plans with defined opportunities, interventions and goals to improve member health outcomes in collaboration with the Interdisciplinary Care Team. The RN Care Coordinator is also responsible for transition of care activities and actively managing their caseloads.
Job functions are performed in accordance with federal and state contractual requirements, AlohaCare’s Model of Care Program, AlohaCare policies and procedures, and NCQA standards.
The Care Coordinator works in collaboration with the clinical operation’s division, plan operations staff, primary care providers and specialists, the member, family members and or caregivers, community agencies, community resources.
Primary Duties & Responsibilities:
Conduct the Initial Medicare Health Risk Assessment and the Medicare Annual Reassessment within the required timeframes in addition to performing additional comprehensive medical and psychosocial health assessments
- Develop an Individualized Care Plan (ICP) for each member as directed by the PCP’s treatment plan and member’s input and preferences and includes recommendations and participation from the Interdisciplinary team.
- Coordinates member, provider and other designated Interdisciplinary Care Team member participation in scheduled weekly Interdisciplinary team meetings. Presents member cases for review with members of the team, including an AlohaCare Medical Director.
- Identifies and assesses member’s physical, psychological, financial and daily living skills need. Coordinates and facilitates services, referrals, and resources directed by the PCP and Interdisciplinary Care team. Actively engages members in post discharge/transition of care activities.
- Coordinates member services with AlohaCare’s internal departments such as Enrollment, Service Coordination, Customer Service, Utilization Management, Behavioral Health, Pharmacy, Quality Improvement and Provider Relations. Additionally coordinates with external interdisciplinary team members such as but not limited to assigned PCP, Specialists, family members/care givers, facility social workers, discharge planners, community and state agencies.
- Generates and monitors utilization reports. Case Load reports and Care Plan Outcomes Summary reports on assigned member population.
- Coordination of non-clinical related activities with assigned Medicare Member Service Navigators who under the direction of the RN Care Coordinator assist with plan education, translation, Loss of Medicaid eligibility, and coordination of non-covered plan benefits.
- Actively participates in activities to improve AlohaCare’s quality of service, including involvement in HEDIS and Star Rating initiatives, Performance Improvement Committees and attending continuing education programs.
- Other related duties as may be assigned by the Population Management Manager and or Sr. Director of Quality Improvement.
Required Qualifications:
- Associate’s Degree
- 1-2 years of experience working in a health care related field as an RN
- State of Hawaii RN Licensure
- Strong knowledge of community resources including: specialty care, behavioral health care resources, inpatient and outpatient community resources.
- Demonstrated ability to assess, evaluate and interpret medical information and understand the concepts of Care Management
- Strong customer service skills, telephone skills, and conflict management/resolution
- Proficiency in Microsoft Word, Outlook and other Microsoft programs including a basic understanding of and ability to enter data/run reports from Excel databases.
Preferred Qualifications:
- 3 years of acute care clinical experience
- Prior medical management experience in a managed care environment preferred.
- Previous Health Plan experience
- LSW or LCSW
- Case Management Certification
Physical Demands/Working Conditions:
- Requires operation computer workstation, including keyboard and video display terminal.
- 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.
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.
How to Apply:
For more information, please contact Josie Gesteuyala, HR Generalist
Phone: 808.973.6339
Email: jgesteuyala@alohacare.org
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