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.

Position Summary:

The primary role of the Community Health Worker is to engage and build relationships with members and providers to improve health outcomes. Community Health Workers will educate and assist actively enrolled AlohaCare members on how to navigate their health plan benefits. The Community Health Worker participates in completion of assessments; care plans; gap closures; and community referrals for our members. The majority of the Community Health Worker’s time may be spent in the field or a community/facility setting conducting face-to-face or home visits or members events with AlohaCare members; locating members in the community who have been unengaged with the health plan; accompanying members to provider appointments; and coordinating member services under the direction of, or in collaboration with, the member’s Lead Care Manager or under clinical supervision in the field, hospital or community health center.

Primary Job Duties and Responsibilities:

Perform initial outreach to conduct education and welcome call as needed.
Engage members and providers in the assessment process.
Conduct appropriate assessments timely via face-to-face or virtual (video chat for members identified as Special Health Care Needs (SHCN) or Rising Risk. Assessments include but are not limited to Health Risk Assessments (HRA) and Health Functional Assessments (HFA) and post discharge and readmission risk assessments.
Collaborate with member, caregiver, and providers to develop a person-centered care plan for each member, based upon findings from the assessments. The plan of care for a SHCN member is known as the Health Action Plan (HAP) and can be facilitated by the CHW.
Implement Care Plan or Health Action Plan for actively engaged SHCN or Rising Risk members.
Members may or may not be assigned directly to the Community Health Worker as the Lead Care Manager. The CHW works in conjunction with a Health Coordinator to meet the needs of members, when necessary.
Meet members as required by standards set by Medicare, Medicaid, or the organization.
- HRAs are conducted initially on enrollment and then annually, at a minimum while in Health Coordination.
- HFAs are conducted initially within 15 days of referral and at least annually thereafter.
- Any change in condition or member request for re-assessment will result in HFA reassessment within 10 days of the event at the preference of the member via in person, video chart or telephonically.
- Health Action Plans for members engaged in Health Coordination: minimum every 90 days in person or via video chat (member’s preference) to monitor and document the Member’s progress.
- Care Plans for members in Rising Risk: minimum every 180 days in person, via video chat or telephonically to monitor and document the Member’s progress.
Under clinical supervision, when required, the CHW interacts with member, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to assist in determining the member’s status and capacity and to assess the options for service delivery including use of health plan benefits and community resources to update a Member’s Health Action Plan.
Execute planned intervention(s) as directed, which include but are not limited to facilitating timely access to services, addressing barriers to care and medications, identifying and providing transportation assistance, if needed, etc., on behalf of the member and provider.
Conduct issue resolution related to the goals of the Health Action Plan or other program benefits. Support member redetermination efforts and initiate enrollment into other program benefits based on eligibility.
Conduct initial post discharge follow up for members engaged in Health Coordination.
Collaborate onsite at Community Health Centers and other provider offices to support their AlohaCare patients with care coordination needs to improve health outcomes.
Assist with locating Unable to Reach (UTR) members to include driving to last known address and talking to providers in the community, community resources and/or shelters to locate member.
Assist with delivering Durable Medical Equipment or prescriptions as needed.
Assist members in completing forms/applications and other necessary documentation for other programs that can assist the member.
Connect member with Social Determinates of Health (SDoH) needs to Community Resources in their neighborhood or area or utilizing the Unite Us tool.
Assist the Care Team with coordination of appointments for members.
Assist the member in maintaining eligibility and connections with other entitlement programs the member may qualify.
Coordinate with AlohaCare Health Coordination staff, and appropriate operational departments/units, as required by the member’s needs (e.g., Utilization Management, Transition of Care, Disease Management, Service Coordination, Travel, etc.), and network physicians/providers to ensure specialty services are in place (when applicable).
Promote positive health outcomes by ensuring members receive comprehensive annual physicals and preventive services.
Complete scheduled and assigned daily activities on the activity log within the Health Edge Guiding Care Management system. Document Service Navigation activities in the Health Edge Guiding Care Management system
Assist the members with translation services and enabling services and coordination of medical benefits, including providing coordination assistance with other Medicaid QI Health Plans.
Perform member outreach calls in collaboration with Quality Improvement projects, and Care Coordination activities related to Medicare HEDIS and STAR Ratings.
Generate and create reports as needed.
Other duties as assigned by supervisor and/or manager.
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 & Qualifications:

High School Diploma

Minimum one (1) year Member Outreach, Care Coordination, Managed Care, Health Care and or previous Health Plan with direct member support experience.

Experience with serving members in the community.

Health plan experience with care coordination responsibilities

Strong verbal and written communication in English.

Requires operation of general office equipment to include PC, Surface Pro 3, fax/copy machine and company phone. Intermediate skill using Microsoft Programs; Word, Excel, Outlook, and PowerPoint.

Possession of a valid driver’s license and auto insurance with access to a reliable, 4-wheel, safety- inspected vehicle.

TB Clearance

First Aid and CPR Certification

Preferred Competencies & Qualifications:

Bachelor’s Degree in Human Services, Sociology, Psychology, or other related field.

Bilingual in Ilocano, Tagalog and/or Korean preferred.

Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, and individuals with physical disabilities.

Ability to complete multiple tasks to ensure timeliness standards are met.

Associate degree or previous equivalent healthcare experience preferred.

Three (3) years of Care Coordination, outreach, and customer experience

Physical Demands/Working Conditions:

Medium work: Walking, standing, and exerting up to 40 pounds of force occasionally, or up to 25 pounds of force frequently, or greater than negligible up to 10 pounds of force constantly to move objects.
May require prolonged sitting up to 4 hours.
Requires operation of a computer workstation, including keyboard and video display terminal.

Salary Range: $24.00 - $32.00 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.

AlohaCare

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