Case Management Manager

AlohaCare; Honolulu (HI); On-site; USD 81,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

401k employer contribution

Paid time off

Job summary

AlohaCare is seeking a Case Management Manager in Honolulu, Hawaii. This role involves leading the case management team, ensuring compliance with health regulations, and improving care for behavioral health members.

The ideal candidate will be an experienced RN or licensed mental health professional with strong leadership skills and a passion for facilitating high-quality health outcomes.

AlohaCare offers a comprehensive benefits package including medical, dental, vision insurance, and a 401k employer contribution.

Qualifications

• Minimum of 3 years of experience managing and developing a team.
• Experience with implementing operational plans.
• Strong knowledge of community resources.

Responsibilities

• Oversee and review case management documentation.
• Direct the daily activities of case management staff.
• Manage escalated and complex care cases.

Skills

Leadership

Communication

Interpersonal Skills

Time Management

Education

Licensed RN, LCSW, LMHC, LMFT, APRN, CSAC or Licensed Psychologist in Hawaii

Master’s degree in related field

Job description

The Opportunity

The Case Management Manager manages the case management team and the care coordination of behavioral health members to develop and assess high-quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Manages escalations and care management issues related to members or providers. Job functions are performed in accordance with the requirements of the QUEST Integration contract and health plan goals and quality outcome metrics.

Primary Duties and Responsibilities

• Oversee and review case management required documentation to maintain compliance with federal and state regulations and contractual agreements.
• Develop, implement, and oversee case management policies and procedures within the case management team based on regulatory requirements and industry standards.
• Direct the daily activities of case management staff including reviewing and approving the caseloads of case management staff based on state requirements, case management staff experience, and member needs.
• Manage escalated and complex care cases and provide guidance to team members to address member concerns related to mental and behavioral health members.
• Manage resolutions of complaints and assist in audits and evaluations related to care programs.
• Develop, implement, and oversee case management programs to facilitate the use of appropriate services and resources.
• Set goals and objectives for case management team to achieve cost-effective healthcare results.
• Work with case management senior management to provide updates and insights on case management team goals.
• Provide feedback to case management team to improve members and provider experience and high-quality care.
• Educate and provide resources for case management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers.
• Assists case management senior leadership with onboarding, hiring, and training new case management employees, recent promotions, and transfers within the department.
• Strategically plan and optimize team resources, ensuring that they are aligned to business needs, initiatives, and performance gaps.
• Provides oversight of field-based case management operations to ensure compliance with all required case management activities, established timeframes, and mandatory reports.
• Ensures alignment and achievement of departmental goals and organizational priorities, including quality, compliance, member outcomes, and cost-of-care targets.
• Accountable for accurate and timely completion of all required reports and assessments, in collaboration with internal departments within AlohaCare.
• Conduct regular performance monitoring and reporting through audits.
• Develop, maintain, and continuously improve reporting and dashboards to track progress, monitor team and individual performance, identify trends, and inform leadership decision-making and corrective actions.
• Ensure accurate and timely completion and submission of required regulatory reports by collecting and validating data, collaborating with internal stakeholders, and maintaining documentation to demonstrate compliance with requirements.
• Implement the strategic goals of AlohaCare’s CCS Integration program, translating them into specific, measurable, operating and business plans.
• Lead efforts and participate in internal and external audits by preparing documentation, ensuring data accuracy and timeliness; respond to audit inquiries and implement corrective actions to address findings and maintain ongoing compliance.
• Work with Quality Improvement and Medical Directors/Psychiatrists to develop and implement metrics that identify and mitigate barriers to improve member’s health care outcomes and goals for independence.
• Create and conduct provider outreach initiatives, and/or training in conjunction with AlohaCare’s Provider Relations Department.
• Develop and maintain strong relationships within the community including State and Federal leaders, providers, vendors, business partners and community alliances.
• Participate in Case Management staff meetings, interdisciplinary care team meetings and staff manager meetings as required.
• Coach Case management staff and foster a culture of leadership development.
• Participate in annual budget development and ongoing monitoring of performance in relation to budgeted goals.
• Attend QUEST/CCS Integration meetings as required.
• Perform duties of departmental Leads during absences or vacancies.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Responsible for maintaining 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.

Qualifications

• Licensed RN, LCSW, LMHC, LMFT, APRN, CSAC or Licensed Psychologist in the State of Hawaii.
• Minimum of 3 years of experience managing and developing a team.
• Experience with implementing operational plans to achieve organizational goals.
• Experience with QExA, QUEST and Medicare programs and working knowledge of managed health care field.
• Experience with individuals who are low-income or have special health care needs, including: HIV/AIDS, developmental disabilities, medically fragile, older adults, and individuals with physical disabilities.
• Strong knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient and SDOH community resources.
• Achieves results, builds trust, communicates effectively, customer and quality focused.
• Strong interpersonal, facilitation and leadership skills with the ability to interact with various departments/ project teams.
• Excellent, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
• Requires use of personal mobile devices (Android or iPhone manufactured in the last 4 years) compatible with our application and email systems.
• Possession of valid driver’s license with access to a reliable insured automobile.
• TB Clearance.
• First Aid and CPR Certification.

Preferred Requirements

• Master’s degree in social work, Health Care Administration, Long Term Services and Supports, Public Health, or related field or equivalent combination of education and experience.
• Measurable success with operational performance and staff development.

Mental, Physical and Environmental Demands

• Work evenings and weekends as needed as the need for services arises.
• May require prolonged sitting - up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.

Salary Range: $81,000 - $110,000 annually

Benefits

AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time‑off, 401k employer contribution, referral bonus and pretax transportation and parking program.

Equal Employment Opportunity Statement

AlohaCare is committed to providing equal employment opportunities 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/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.