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 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 TOC Care Coordinator, Clinicain is responsible for completing a face to face TOC Assessment with member prior to being discharged from the hospital and/or conducting a telephonic TOC Assessment as required. Also responsible for other Transition of Care activities, referrals to Health Coordination, Behavioral Health, Disease Management, Care Navigators, Community Health Workers, Pharmacy and assistance with outreach to Resource Organizations as necessary.

The TOC Care Coordinator, Clinician works in collaboration with clinical operations staff, primary care providers and specialist, community resources, the member, family members and/or caregivers. Job functions with requirements of Med-QUEST, QUEST Integration, Medicare contractual performance policies and procedures and NCQA standards.

Primary Duties & Responsibilities:

• Conduct a face to face and/or telephonic TOC assessment on complex care members prior to member being discharged from the hospital (Oahu) and post hospitalization. A TOC assessment will be completed with members who have complex admissions, readmissions, and/or have the potential of becoming high risk and complex, to include frequent Emergency Department utilization. TOC care collaboration with neighbor island members upon discharge from the hospital is achieved telephonically.
• Interacts with member, family, provider(s) utilizing clinical and social knowledge and expertise to determine the member’s current status and capacity to assess the options for service delivery.
• Assist member with scheduling the PCP and/or Specialist post discharge follow-up appointments, transportation, and DME needs post hospitalization.
• Provides individual member education on preventative health care measures and on medication education and compliance.
• Upon member discharge, ensure PCP/Specialist has current member information to include the discharge instruction, discharge summary, current medication list or and other information requested.
• Conduct a follow-up phone call with member post discharge, after the scheduled PCP and/or Specialist follow-up appointment, and as needed throughout the TOC 30 Day Program.
• Assist member with outreach to Community Health Centers, primary care provider and/or Specialist as needed.
• If necessary, refer member to Health Coordination, Behavioral Health, Disease management, Care Navigators, Community Health Workers and Pharmacy departments when additional assistance is required.
• Maintains accurate and up to date written documentation and records of TOC activities in information system (Guiding Care/G8) according to appropriate TOC and/or clinical guidelines.
• Ensures compliance with all state and federal regulations, including HIPAA standards of confidentially protected health information, reporting of critical incidents and reporting of quality of care issues.
• Participate in TOC Care Coordination staff meetings, interdisciplinary care team meetings, trainings, in-services, Inpatient Rounds and Behavioral Health Rounds as required.
• Other duties as assigned.
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, and rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Required Competencies & Qualifications:

• Associates Degree in Health Care Administration, Nursing, Long Term Services and Supports, Public Health, Behavioral Health or related field.
• Licensed Clinician to include LPN, RN, LSW or LCSW in the State of Hawaii.
• 1+ year of related work experience in a clinical setting and/or in a managed care environment, experience with behavioral health case management, health plan experience, or other related work experience.
• Experience with performing post-inpatient transition of care activities.
• Ability to solve problems.
• Ability to work in high stress environment, sporadic fluctuations in workload at times.
• Ability to deal with providers, members, and family members in a constructive manner.
• Ability to work with varied teams/professionals for inter-disciplinary case consultation and discharge planning.
• Ability to network with other providers for successful transition from inpatient to community-based services.
• Prior experience in clinical assessments, discharge planning and utilization management.
• Support AlohaCare’ s corporate core values in all interactions.
• 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, ability to communicate clearly (verbally and in writing) across departments and providers to facilitate action plans.
• Possession of valid driver's license with access to a reliable automobile.
• TB Clearance
• First Aid and CPR Certification

Preferred Qualifications:

• Experience with QUEST and Medicare programs and working knowledge of managed health care field.
• 1 + year of related work experience, health plan experience, experience in a clinical setting and/or in managed care environment.
• Experience with individuals who are low-income or have special health care needs, including: HIV/AIDS, developmental disabilities, medical -fragile, older adults, and individuals with physical disabilities.
• Knowledge of local resources, providers, and referral processes.

Physical Demands/Working Conditions:

• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled work day.
• May require occasional lifting, up to 20 pounds

Salary range: $65,000 - $85,000 annually

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.