DSNP Care Navigator

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, and drug insurance, PTO plan, 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 primary role of the Dual Eligible Special Need Plan (D-SNP) Care Navigator is to assess and assist actively enrolled low-risk and unengaged D-SNP members with understanding their health care benefits and accessing providers and services. The majority of the D-SNP Care Navigator’s time is spent telephonically reaching out to members to ensure they have access to care from in-network providers, community resource providers and plan benefits under the direction and in collaboration with the Interdisciplinary Care Team.

Primary Duties and Responsibilities:

• Perform initial outreach to complete welcome calls for newly enrolled D-SNP members.
• Schedule and complete required initial and annual telephonic health risk assessments (HRA) for D-SNP members as required by regulatory agencies.
• Create initial and update Care Plan for D-SNP members after HRA completion as required by regulatory agencies.
• Engages member/providers to participate in the assessment process and collaboratively develop a person-centered Care Plan for each D-SNP member as required by regulatory agencies.
• Provide telephonic support for inbound routine and complex calls received from D-SNP members and providers via call transfer.
• Provide D-SNP member education and assist with referral coordination and prior authorizations per member needs and eligibility.
• Document in an electronic care management system all assessment information and care management activities.
• Review prior assessments and historical claims to identify any signs of health status changes to assess D-SNP member’s level of care and/or prior to completing new assessment.
• Coordinate, collaborate, and participate with the interdisciplinary care team members including providers, family members, caregivers and community agencies to support members in maintaining or improving their current health status.
• Coordinate and collaborate with the appropriate internal departments as required per D-SNP member’s needs (e.g., Medical Management, Transition of Care, Disease Management, Care Coordination, Service Coordination, Travel, etc.) and in-network physicians/providers and community resource providers to facilitate timely access to available and approved services.
• Perform member outreach calls for care management related to D-SNP member’s routine health screenings and outcome that may include but is not limited to data collection for HEDIS, STAR measures, and other D-SNP member health plan events.
• Assist the member with accessing translation services when needed and requested.
• Generating daily if not weekly Excel reports for daily work assignment and prioritize of assigned duties.
• Performing other duties as assigned by supervisor and/or manager per departmental needs.
• Responsible to maintain AlohaCare’s 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.

Required competencies and qualifications

• High School Diploma/Equivalent
• 2 or more years of work experience in a customer service role, call center environment, and/or with customer facing responsibilities
• Ability to establish rapport/relationship with members via a telephonic interview which includes gathering information about their medical history and/or socio-economic needs
• Ability to establish rapport with a multi-cultural - diversified population and experience with cultural sensitivity
• Professional telephonic etiquette skills
• Strong oral and written communication skills with high attention to detail
• Strong active listening skills for telephonic member assessments
• Strong problem-solving skills needed to address member concerns
• Strong customer service skills with knowledge of interviewing techniques
• Ability to be diligent, detail-oriented, with key organizational skills to ensure prioritization and efficiency
• Ability to work independently while also contributing to team, departmental and business goals
• Flexibility and adaptability to changes of process and/or priorities
• Strong multi-tasking skills with the ability to perform tasks in a fast-paced work environment
• Intermediate skills using Microsoft Programs: Word, Excel, Outlook and PowerPoint.

• General knowledge and operations of general office equipment to include: PC, fax/scanner/copy machine and desk phones.
• Ability to work remote

Preferred Requirements

• Ability to speak and read fluently in other languages
• Knowledge of available community resources
• Prior experience in care coordination, outreach or customer service in a managed care environment
• Experience utilizing EMR or care management system to complete tasks
• Associate’s degree or equivalent training in health care, insurance or medical practice

Physical and Environmental Demands:

• Ability to travel inter-state with occasional overnight stays
• 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.
• In-office working conditions, participation in community outreach events as needed
• No environmental hazards

Salary Range: $19.75 - $25.75

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.

Salary : $20 - $26