Job description

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 Company: 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 educate and
assist actively enrolled AlohaCare members on how to navigate their health
plan benefits. The Community Health
Worker participates in completion of the health and functional assessment and
health action plan. The majority of the Health
Coordinator’s time is spent in a field/outreach setting conducting face-to-face
home visits with members and locating unable to reach members, accompanying
members to provider appointments and coordinating member services under the
direction and collaboration of the member’s Lead Care Manager or under clinical
supervision. Primary
Job Duties and Responsibilities: ·
Perform initial outreach to conduct education
and welcome call as needed.
Conducts
face-to-face or virtual (video chat) to collect data for the Health and Functional
Assessments (HFA) for members Special Health Care Needs
Engages
member/providers to participate in the assessment process and
collaboratively develops a person centered Health Action Plan for each
member, based upon the HFA and other assessment
Under clinical
supervision, Interacts with member, family, physician(s), and other
providers utilizing clinical and social knowledge and expertise to assist
in determining the member’s current 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.
Meets with the
member at a minimum every 90 days in person or via video chat to monitor
and document the Member’s progress in the Health Action Plan.
·
Schedule and attend member home visits and
provider visits, if needed. Complete
required Initial and annual member reassessments for members assigned. The Community Health Worker will execute
planned non-clinical intervention(s) as directed, which include but are not
limited to facilitating timely access to services, ensuring there are no
barriers to care and medications, identifying and providing transportation
assistance, if needed, etc., on behalf of the member and provider.·
Assist with locating Unable to Reach members
to include driving to last known address and talking to providers in the
community, 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 to Community Resources in their
neighborhood or area.·
Assist 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).·
Share the member’s Health Risk Assessment
(HRA) and member’s Individual Care Plan (ICP) with appropriate network
physicians. Promoting the medical home
and ensuring members receive comprehensive annual physicals and preventive
services.·
Manage and meet periods for completing
scheduled and assigned daily activities on the activity log within the
Altruista Guiding Care Management system.
Document Service Navigation activities in the Altruista Guiding Care
Management system·
Assist the member (when needed) 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.·
Contact the member to complete the DNR
(Disenrollment Survey).·
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: •
Bachelors 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 •
Associates 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 hourAlohaCare 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.

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