Exempt or Non-ExemptExempt
Job Summary
**Hybrid Work Environment - Must reside on Hawaii Island**
Pay Range: $53,996 - $79,258
Note: Individuals typically begin between the minimum to middle of the pay range
To provide care coordination for eligible HMSA members and facilitate a collaborative relationship among members, providers, community agencies and HMSA staff to ensure members receive timely and integrated access to services. Case Managers/Health Coordinators with Implementing the health action plans/care plans.
Minimum Qualifications
- Bachelor's degree and three years of case management experience conducting assessments and home/community visits.
- Effective communication skills and time management skills
- Excellent interpersonal, problem-solving, and organizational skills
- Exhibit cultural sensitivity to people of various ethnic origins and socioeconomic backgrounds.
- Intermediate working knowledge in Microsoft Word and Outlook.
- Basic working knowledge in Microsoft Excel and PowerPoint.
- Must have valid driver's license, access to an automobile with current license, registration and no-fault insurance.
- Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
Duties and Responsibilities
- Manage members that have been assessed by the LTSS, Event Driven Care, or Complex Case Management Case Managers/Health Coordinators to implement member's health action plans (HAP)/care plans to ensure timely services are in place. This may include initiating the process of ADRC, going home plus, self-directed packets, contacting providers (i.e., follow-up for members, making appointments, finding availability to meet HAP/care plan goals), and submitting/following up on precertification requests to medical management department.
- Review Health Action Plans/Care Plans to meet RFP requirements. This may be conducted in person, telephone, email, fax, or video.
- Manage patient care by establishing and managing efficient and effective relationships between providers, members, and HMSA to ensure timely access to appropriate medical care.
- Document on HMSA's electronic record systems that includes meeting NCQA, CMS, and Med-QUEST Division (MQD) requirements/standards.
- Advocate and assist members to navigate HMSA and the health care delivery system.
- Attend required trainings and then apply to day-to-day work.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.