Care Manager, LTSS

HMSA; Keaau (HI); Hybrid; USD 68,000 - 133,000; Full time

Benefits offered by this job

Hybrid work environment

Job summary

HMSA is seeking a Care Manager to provide specialized care coordination for members, focusing on LTSS, HCBS, and safe transitions. The role collaborates with physicians, nurses, social workers, and other care professionals to improve health equity, access, and outcomes.

Responsibilities include evaluating needs, authorizing home-based services, reducing hospital utilization, and advocating for members while ensuring HIPAA privacy and strong documentation.

Qualifications

• Three years of relevant healthcare or clinical experience or equivalent
• Strong documentation and research abilities
• Ability to analyze information, make decisions and communicate clearly
• Interpersonal skills and integrity in a fast-paced setting
• Proficiency with Microsoft Office applications (Word, Outlook, PowerPoint)
• Experience with electronic medical records (EPIC, HHIE) and HIPAA regulations

Responsibilities

• Assess and plan by conducting comprehensive physical, psychosocial, and health literacy evaluations
• Apply critical thinking to analyze cases and inform care plans
• Partner with the member to develop actionable care plans to prevent avoidable utilization
• Educate members and families with clear information and collaboration
• Coordinate a multidisciplinary team to ensure timely access to medical and behavioral health services
• Engage in quality improvement initiatives and mentor colleagues to promote best practices
• Advocate for members with thorough documentation of all care activities

Skills

Healthcare experience

Documentation

Analytical thinking

Interpersonal skills

Microsoft Office

EPIC

HHIE

HIPAA compliance

Education

Hawaii licensed healthcare professional

Tools

EPIC

HHIE

Job description

• Hybrid Work Environment - Must reside on Maui or Hawaii Island **

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

• Hybrid Work Environment - Must reside on Maui or Hawaii Island **

Pay Range: $68,000 - $133,000

Note: Individuals typically begin between the minimum to middle of the pay range

The Care Manager is an experienced licensed healthcare professional who is uniquely qualified to provide care management for members. The position collaborates with a multidisciplinary team--including physicians, nurses, social workers, and/or other care professionals--. The position partners with healthcare providers, members, and authorized representatives to oversee care delivery and advocate for improved health equity, access, and outcomes. The position is accountable for achieving organizational goals and key performance indicators (KPIs), with a focus on enhancing member experience, reducing morbidity, mortality, and hospital utilization, and minimizing overall healthcare costs.

• Provides care management for members needing long-term services and supports (LTSS) to include home and community-based services (HCBS), residential settings, and nursing facilities.
• Authorizes appropriate home-based community services.
• Addresses care gaps and reduces risk of inpatient admissions and emergency department utilization.
• Conducts evaluations (i.e., DHS 1147) for nursing facility level of care services.
• Facilitate effective communication and collaboration with interdisciplinary healthcare teams including care pod members with Community Health Workers (CHWs).

Minimum Qualifications

• Three years of relevant healthcare or clinical experience; or equivalent combination of education and experience.
• Demonstrates thorough expertise in care transitions with little supervision required.
• Possesses strong documentation and research abilities, can analyze information, make decisions, and communicate effectively both verbally and in writing.
• Displays interpersonal skills, resolves conflicts, and acts with integrity.
• Highly organized, able to multitask independently, fostering adaptability and teamwork.
• Performs well in a fast-paced setting and readily adapts to changes.
• Delivers outstanding customer service to both internal and external clients.
• Utilizes excellent analytical and critical thinking to evaluate medical necessity and the suitability of patient services and treatment individually.
• Safeguards patient privacy in accordance with Federal (HIPAA), organizational, and departmental regulations.
• Clearly communicates with providers and health care teams while building collaborative relationships.
• Intermediate working knowledge in Microsoft Office applications, including but not limited to Word, Outlook, and PowerPoint.
• Experience with electronic medical records such as EPIC and HHIE.
• Healthcare Professional license in the State of Hawaii*
  • *(upon hire, proof of licensure to be provided by employee to Human Resources as well as a signed "Clinical Affirmation Statement for RN/LSW" form if applicable)
• Reliable transportation to perform in person (Face to Face) meetings or in alternative settings.

Duties And Responsibilities

• Assessment & Planning
  • Conducts comprehensive assessments--including physical, psychosocial, and health literacy evaluations--and interprets relevant diagnostic data to identify member and family needs.
  • Applies critical thinking skills to analyze complex cases and determine underlying causes contributing to high costs. Uses these insights to inform individualized transition/treatment plans and address gaps in care delivery.
  • Partners with and empowers the member to develop an actionable care plan that helps prevent avoidable utilization.
• Collaboration & Education
  • Assesses educational needs of members and families, ensuring clear and sufficient information is provided.
  • Facilitate effective communication and collaboration with interdisciplinary healthcare teams, including the member, their support person(s), other family members and external stakeholders to develop, implement, and evaluate individualized care plans, and to address systemic challenges in member care.
• Care Coordination and Delivery
  • Coordinates a multi-disciplinary team to include but not limited to member's PCP, specialists, the member, caregivers, and other members of the healthcare team to ensure timely access to appropriate medical care, behavioral health care, and services
  • Coordinates and monitors activities among internal departments, external community agencies.
• Quality Improvement & Leadership
  • Engages in quality improvement initiatives, supports leadership in system-level improvements, analyzes data for program enhancement, and mentors' colleagues to promote best practices.
• Advocacy & Documentation
  • Advocates for members and families across the healthcare continuum and ensures thorough documentation of all care activities.
• Performs all other miscellaneous responsibilities and duties as assigned or directed