Senior Manager of Health Coordination and LTSS
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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.
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.
The Senior Manager of Health Coordination and LTSS is responsible for carrying out the mission and goals of this business unit within Health Services, serving members in the MedQUEST and Medicare DSNP programs. The Senior Manager’s objectives involve an integrated relationship with field-based clinical staff and providers and the medical management team, striving toward increasing access to appropriate LTSS services as well as other services to support the member to stay as independent as possible in the care setting of their choice. The quality and financial goal of the Senior Manager is to ensure SHCN and EHCN and LTSS members have access to the appropriate level of health intervention to decrease the potential of moving toward high health service utilization, poor quality outcomes, and escalating avoidable costs. The Senior Manager’s goal is also to collaborate with internal and external Health Coordination teams and providers to facilitate the movement of members from one care level to the next ensuring the appropriate level of services and care coordination intervention is provided in the least restrictive setting. The Senior Manager aligns the department and internal or externally delegated Care and Service Coordination Teams and providers with Aloha Care’s mission, vision, values, and strategies.
The Senior Manager of Health Services also provides administrative oversight and monitoring of the Medical Management of Long term services and supports (LTSS), and work in conjunction with the Health Coordination Directors to provide oversite to the internal and external Health Coordination teams in providing LTSS interventions. The Senior Manager of Health Coordination and LTSS supervises a team of Health Coordinators, Community Health Workers and Assistant Health Coordinators as well as supports the professional nursing staff performing utilization reviews ensuring that members receive health care and services that meet all contractual and regulatory requirements for quality, timeliness and access. The quality and financial goal for the Senior Manager is to decrease total cost of care by ensuring provision of appropriate supports and services.
Primary Duties and Responsibilities:
Provides oversight of AlohaCare’s LTSS program to ensure compliance with requirements/standards set by DHS, CMS, and NCQA.
Manage operations to achieve departmental goals and objectives in satisfying or exceeding contractual obligations, accreditation standards and service to members and providers.
Manage the budgetary and financial aspects of the department
Knowledgeable of key requirements (contractual, regulatory, accreditation) related to LTSS services and the reference materials supporting these
Ensures all LTSS policies and procedures required are kept up to date, accurate and meeting requirements
Make business decisions that consider organizational policies and procedures, Business Conduct Guidelines, transparency and accountability, and financial or budgetary impact
Establish internal controls and feedback processes that enable rapid identification of significant trends or variances in operations and early responses
Commit to and execute continuous training and learning through different activities and ventures
Participate actively in Manager-oriented meetings
Monitoring and communicating LTSS performance measures and comparing and sharing results against requirements or other established benchmarks with Senior Director and VP of Health Services.
Participates in appropriate MQD LTSS workgroups and other workgroups as assigned
Coordinates with the clinical trainer on developing and providing LTSS training
Monitoring LTSS utilization to ensure that treatment is provided at the least restrictive level of care that supports quality outcomes
Responsible for working with Senior Director on completion, validation and timely submission of all required reports based on the plan’s contractual obligations to the State/MQD, CMS, and any accreditation body/entity (e.g. NCQA).
Participates in the Quality Improvement process 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 and primary care and LTSS providers (e.g. QUEST Integrated activities) to support LTSS
Collaborates with Project Echo and other external agencies to promote and ensure provision of educational and training opportunities for LTSS providers
Triages and coordinates resolution of LTSS escalated issues as requested by MQD and/or Senior Directors or VP of Health Services.
Provides consultation, education, and training to LTSS providers and other providers in conjunction with AlohaCare’s Provider Network Development Department.
Participates in regional community team meetings with primary care and other providers supporting community coalitions to increase/improve the promotion of the network available to AlohaCare members, as well as promoting understanding of LTSS in the primary care setting
In conjunction with Health Directors, and with providers address undesirable individual or group behaviors that require disciplinary action, collaborating with Human Resources
Communicate with internal and external teams, continuously, through a variety of modes or venues, including regular team meetings and regular 1:1 meetings.
Reviews audit outcomes with clinical performance consultant team and provides feedback and training to support improved performance outcomes to the Health Coordination team.
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
• Plan level of staffing
• Work closely with Human Resources in planning, recruiting, choosing, hiring new staff, ensuring a formal on-boarding process
• Oversee and direct staff in accordance with AlohaCare’s policies and procedures and emphasizing the importance of staff health and safety
• Develop staff through coaching, mentoring, training, individualized career plan, and providing opportunity for continuous development, retaining talented individuals
• Delegate responsibility with its accountability to empower staff
• Allow for disagreement and conflict, fostering the values of teamwork and resolution that enhances the staff and department to be successful
• Train the staff in self-management of performance to encourage growth, participation, and achievement
• Recognize individual or group accomplishments
• Address undesirable individual or group behaviors that require disciplinary action, collaborating with Human Resources
• Maintain work schedules of staff, based on rules of fairness, customer service, PTO, tele-commuting
• Communicate with staff, continuously, through a variety of modes or venues, including regular 1:1 meeting.
Required Competencies and Qualifications
• 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).
• 3+ years’ experience in LTSS Care Management
• Minimum of 5 years of supervisory experience
• Excellent skills in organizing, communicating, team building, and time management
• Demonstrated ability to partner with multiple stakeholders, such as care team, primary care provider, behavioral health clinician, health service administrators, external parties
• Proficiency in in common software systems such as Microsoft Suite
• 5+ years of experience working with consumers of LTSS services and providers
• Experiences that indicate abilities in problem solving and decision making.
• Unrestricted and current RN license in State of Hawaii Senior
• Bachelors or higher degree
Preferred Competencies and Qualifications
• Experience working with Medicaid and Medicare populations
• Experience with implementing LTSS programs in Hawaii
• Experience with field care management
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
• Requires frequent travel and interaction with team members and providers.
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.Position Description »