Case Management Manager

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

Benefits offered by this job

Low-cost medical insurance

Dental insurance

Vision insurance

Paid time-off

401k employer contribution

Referral bonus

Pre-tax transportation and parking

Job summary

AlohaCare in Honolulu, HI, is seeking a Case Management Manager to lead the case management team focused on behavioral health care outcomes. You will supervise daily activities, ensure regulatory compliance, and coordinate care with providers under QUEST Integration.

The role requires strong leadership, budget oversight, and experience with Medicare programs, with a willingness to travel as needed and to mentor staff toward high-quality, cost-effective care.

Qualifications

• Minimum of 3 years of experience managing and developing a team.
• Experience with QExA, QUEST and Medicare programs.
• Knowledge of regulatory compliance and quality guidelines.
• Ability to travel interstate with overnight stays.

Responsibilities

• Oversee case management documentation to maintain regulatory compliance.
• Develop and oversee case management policies and procedures.
• Direct daily activities of case management staff and approve caseloads.
• Manage escalated and complex care cases and guide staff.
• Develop and oversee programs to facilitate services and resources.
• Set goals for cost-effective healthcare results.

Skills

Team management

Regulatory compliance

Communication skills

Interpersonal skills

Project coordination

Education

Registered Nurse license (Hawaii)

Social Worker/Clinical licensure

Tools

QExA

QUEST program knowledge

Medicare programs knowledge

Job description

Are you ready for new challenges and new opportunities?

Join our team!

Current job opportunities are posted here as they become available.

Subscribe to our RSS feeds to receive instant updates as new positions become available.

AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

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.

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 implementing 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.
• 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, communicate 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:

• Ability to travel interstate with occasional overnight stay.
• 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

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.