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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 benefit 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.
Position Summary:
The Grievance Leads ensures that response to grievances and appeals is done in a timely, professional, customer-focused manner, and is well documented. Ensures that case documents are audit-ready and grievances and appeals are handled per QUEST Integration, CMS, NCQA, and other accreditation and regulatory requirements and AlohaCare standards.
Primary Duties and Responsibilities:
Required Qualifications:
Associate’s degree or equivalent combination of education and experience
2 - 3 years of related work experience
Strong verbal and written communication in English.
Requires operation of general office equipment to include: PC, fax/copy machine and ACD Midel Phones and proficient knowledge of Microsoft Office tools
Achieves results, builds trust, communicates effectively, customer and quality focused.
Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
Ability to organize and coordinate information with multiple departments and different staff levels, including management
Strong problem solving and customer service skills
Self-Initiative
Experience with utilizing multiple databases
Engages in Process Improvement
Preferred Qualifications:
Experience in conducting training
Health plan experience
Knowledge of Medicaid, Hawaii QUEST Integration Program, and/or Medicare
Grievance & Appeal processing experience
Bachelor’s Degree
Physical Demands/Working Conditions:
Inside working conditions
No environmental hazards
Ability to conduct training; potentially with audiovisual presentations
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.
Salary Range: $19.75 - $26.00 an hour
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.