- Performing initial outreach to complete welcome calls for newly enrolled members.
- Scheduling and completing required initial and annual telephonic health risk assessments.
- Provide telephonic support for inbound routine and complex calls received from members and providers via a call center queue.
- Providing member education and assisting 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 member's level of care and/or prior to completing new assessment.
- Coordinating, collaborating, and participating 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.
- Coordinating and collaborating with the appropriate internal departments as required per 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.
- Performing member outreach calls for care management to include data collection for special projects such as HEDIS, STAR measures, and member health plan events.
- Assisting the member with accessing translation services when needed and requested.
- Coordination of daily administrative responsibilities of documents copying, mailings, and faxes.
- 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.
- 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 ACD Mitel Phones.
- Ability to work remote
- 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
- 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
-
Health Care Navigator
3 weeks ago
Kaiser Permanente Waipahu, United StatesJob Summary: · As a Health Care Navigator, you will engage people in emotionally powerful ways. Your ability to build trusting relationships and connections are foundational to improving health outcomes and making a positive difference. · The Health Care Navigator (HCN) is respon ...
-
Health Care Navigator
3 weeks ago
Kaiser Permanente Waipahu, United States: Job Summary: · As a Health Care Navigator, you will engage people in emotionally powerful ways. Your ability to build trusting relationships and connections are foundational to improving health outcomes and making a positive difference.The Health Care Navigator (HCN) is respons ...
-
Health Care Navigator
3 weeks ago
US VETS Inc Kapolei, United StatesJob Details · Level · Experienced · Job Location · USVETS Barbers Point - Kapolei, HI · Position Type · Full Time · Education Level · Graduate Degree · Salary Range · $45, $50,000.00 Salary · Job Shift · Day · Job Category · Health Care · Description · Health Care N ...
-
Travel Nurse RN
1 week ago
Travel Nurses, Inc. Honolulu, United StatesTravel Nurses, Inc. is seeking a travel nurse RN ICU - Intensive Care Unit for a travel nursing job in Honolulu, Hawaii. · Job Description & Requirements · Specialty: ICU - Intensive Care Unit · Discipline: RN · Duration: 12 weeks · 36 hours per week · Shift: 12 hours, days · Emp ...
-
Patient Navigator Associate
1 week ago
The Queen's Health Systems, Inc. Honolulu, United States Full timeSupports the coordination of patient care and internal external/resources to ensure that care is provided in a supportive, seamless, and superior customer approach at all times. - Performs duties and responsibilities in accordance with policies and p Associate, Mammography, Navig ...
-
Family Medicine Physician
1 week ago
Queen's Health System Honolulu, United StatesRESPONSIBILITIES · Molokai General Hospital (MGH) is a 15-bed rural health care facility with a Critical Access Hospital designation. It provides the only emergency room for the residents and visitors on the island of Molokai. MGH became a part of The Queen's Health Systems in 19 ...
-
Health Plan Navigator I
2 weeks ago
Hawaii Medical Service Association Honolulu, United StatesJob Summary · Worksite Location (In-Office): Honolulu, Oahu · Pay Range: $37,715 - $54,447 · Note: Individuals typically begin between the minimum to middle of the pay range · The Health Plan Navigator guides members through the complexities of HMSA's health plan benefits and ...
-
Coordinator, Breast Health
2 weeks ago
Hawaii Pacific Health Honolulu, United States Full time RegularJob Description · Kapi'olani Medical Center for Women & Children is Hawai'i's only maternity, newborn and pediatric specialty hospital. It is well recognized as Hawai'i's leader in the care of women, infants and children. With 253 beds, the not-for-profit hospital delivers 6,000 ...
-
Medical Scribe
1 week ago
ScribeAmerica Honolulu, United StatesJob Description: · 20 years ago we set the standard for medical scribes. Today we're redefining it. · ScribeAmerica is a growing organization with real opportunities to advance your career in the healthcare field. Join physicians and providers on the front lines and gain valuable ...
-
Pharmaceutical Sales Representative
2 weeks ago
BioSpace, Inc. Honolulu, United StatesJob Details · At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need t ...
-
Pharmaceutical Sales Representative
1 week ago
Eli Lilly Honolulu, United States Full timeAt Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need them, improve th ...
-
Travel Nurse RN
1 week ago
Travel Nurses, Inc. Honolulu, HI, United StatesTravel Nurses, Inc. is seeking a travel nurse RN CVICU for a travel nursing job in Honolulu, Hawaii. · Job Description & Requirements · Specialty: CVICU · Discipline: RN · Duration: 12 weeks · 36 hours per week · Shift: 12 hours, days · Employment Type: Travel · Job Description · ...
-
Dental Hygienist
3 weeks ago
Waikiki Health Center Honolulu, United StatesFounded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health Center (FQHC) that offers a Patient-Centered Medical Home targeting our community's most vulnerable populations. Our clinical and program sites provide holistic care in welcoming, supportive, and nonjudgme ...
-
Dental Hygienist
3 weeks ago
Waikiki Health Center Honolulu, United StatesFounded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health Center (FQHC) that offers a Patient-Centered Medical Home targeting our community's most vulnerable populations. Our clinical and program sites provide holistic care in welcoming, supportive, and nonjudgme ...
-
Dental Clinic Manager
3 weeks ago
Waikiki Health Center Honolulu, United StatesFounded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health Center (FQHC) that offers a Patient-Centered Medical Home targeting our community's most vulnerable populations. Our clinical and program sites provide holistic care in welcoming, supportive, and nonjudgme ...
-
Occupational Therapist
3 weeks ago
Sigma Honolulu, United StatesOccupational Therapist - Honolulu, HI - 13 Weeks Contract · Sigma Healthcare team is looking for an Occupational Theraist to work onsite our client's facility in Honolulu, HI. · Shift: Monday - Friday, Days. · Summary:Provide Occupational Therapy and related services for pati ...
-
Dental Patient Services Representative
3 weeks ago
Waikiki Health Center Honolulu, United StatesFounded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health Center (FQHC) that offers a Patient-Centered Medical Home targeting our community's most vulnerable populations. Our clinical and program sites provide holistic care in welcoming, supportive, and nonjudgme ...
-
Dental Patient Services Representative
2 weeks ago
Waikiki Health Center Honolulu, United StatesFounded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health Center (FQHC) that offers a Patient-Centered Medical Home targeting our community's most vulnerable populations. Our clinical and program sites provide holistic care in welcoming, supportive, and nonjudgme ...
-
Kidney Care Advocate
6 days ago
Fresenius Medical Care North America Honolulu, United States**PURPOSE AND SCOPE:** · Under the direction of a Kidney Care Advocate Manager, collaborates with internal and external care teams, to ensure a positive experience for every patient living with kidney disease through education, modality options, access placement and follow throug ...
-
Wellness Partners Hawaii, Inc Honolulu, United StatesJob Description · Job DescriptionIt is Wellness Partners Hawaii's mission to provide accessible and quality mental health care to the communities in the state of Hawaii. Our vision is to continuously expand our connection, ability and services to provide care across all levels of ...
Care Navigator - Honolulu, United States - AlohaCare
Description
Job Description
Job DescriptionApply on line at
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 Care Navigator is to assess and assist actively enrolled low-risk members with understanding their health care benefits and accessing providers and services. The majority of the 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:
Required competencies and qualifications
Preferred Requirements
Physical and Environmental Demands:
Salary Range: $19.75 – $ 25.00 hourly range
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.