Behavioral Health Program Manager

Apply online 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.

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The Opportunity:

The Behavioral Program Health Manager provides administrative oversight and clinical guidance of the Behavioral Health Program. Partners with BH Director to ensure compliance with AlohaCare’s policies and procedures, DHS, CMS, NCQA requirements for behavioral health services. This role is a a resource to other departments in addressing members with behavioral health needs in support of a process of recovery

Primary Duties and Responsibilities:

• Provides oversight of AlohaCare’s Behavioral Health program to ensure compliance with requirements/standards set by DHS, CMS, and NCQA. Oversight activities include:
• Being aware and knowledgeable of key requirements (contractual, regulatory, accreditation) related to behavioral health services and the reference materials supporting these.
• Ensuring all P&Ps required are kept up to date, accurate and meeting requirements
• Monitoring and publishing departmental performance measures and comparing results against requirements or other established benchmarks and institute corrections as necessary

• Responsible for completion, validation and timely submission of all required Behavioral Health reports based on the plan’s contractual obligations to the State/MQD, and CMS.

• Participates in the Quality Improvement process along with the BH Coordinator to ensure that quality care and services are provided to the member in a timely manner. This includes monitoring processes and documentation as well as identifying and researching potential quality of care issues and forwarding information to the Quality Improvement Department.
• Monitors/ Coordinates activities with the other AlohaCare Departments (e.g. QUEST Integrated activities) to support and achieve department goals and initiatives.
• Has oversight and monitors referrals to specialized programs, such as the Child & Adolescent Mental Health Division (CAMHD) for SEBD services, and Community Care Services (CCS) for adults who may need additional and intensive behavioral health services
• Triages and coordinates resolution of BH escalated issues as requested by MQD and/or Director.
• Participates in appropriate MQD workgroups as identified by BH Director
• Provides consultation, education, and training to plan staff and/or identifies outside partners who are willing to provide our staff with such opportunities.
• Provides consultation, education, and training to providers in conjunction with AlohaCare’s Provider Network Development Department.
• Identifies and develops community and other resources available to assist with member needs.
• Participates in community meetings such as but not limited to the “National Alliance for the Mentally Ill” (NAMI), Mental Health America, or community coalitions to increase/improve network of services available to our members, as well as to promote AlohaCare’s presence in the community as identified by BH Director.
• Ensures behavioral health representation at the Inter-disciplinary department team meetings or Inter-disciplinary care team meetings, as well as other ad-hoc meetings.
• Participates in Managers meetings
• Participates in the Provider Advisory Council meetings
• Participates in organizational workgroups or coordinates BH representation by other BH staff, as appropriate
• 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.
• Provides Direct oversite, training, guidance and mentoring to the Certified Peer Specialist positions as well as for the BH administrative position
• Participates in UM rounds as needed/indicated.
• Supports team TOC/BH/Housing with inpatient member engagement and discharge planning with a focus on After4care appt scheduling as needed.
• Assists/Completes needed 1157 forms, or other BH screening tools, if applicable/needed.
• Monitor, report and strategize with health Services on how to reduce readmissions
• 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 Qualifications

• Masters/ bachelor’s degree in social work, or a related field.
• 2-3 years’ work experience as a case manager in a community setting.
• Observed leadership competency with 3 years of supervisory experience in a behavioral health related field.
• Strong knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient community resources.
• Knowledge of the managed health care field (both conceptually and operationally).
• Proficiency in Microsoft Word and Outlook with basic understanding of and ability to enter data/run reports from Excel or Access databases.

Required Licensure/Certification

A Qualified Mental Health professional - LCSW, LMHC or LMFT

Preferred Qualifications

Experience working with Medicaid and Medicare populations

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.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC
• Requires own transportation to attend off site visits

Salary Range: $81,000 - $100,000 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.

Salary : $81,000 - $100,000