Case Manager, Hawaiian Islands

Alohacare; Honolulu (HI); On-site; USD 70,000 - 83,000; Full time

Benefits offered by this job

Low-cost health insurance

Dental & vision insurance

Paid time off

401k employer contribution

Referral bonus

Pre-tax transportation and parking

Job summary

AlohaCare seeks a dedicated Case Manager to assess, develop, and facilitate complex care management for members with mental health needs. You will educate families, coordinate with providers, and ensure access to services across behavioral health and social determinants.

The role requires 2+ years in related work, Hawaii regulatory familiarity, and the ability to work in a fast-paced team. AlohaCare supports professional growth and inclusive care delivery.

Qualifications

• Associate degree in behavioral health or related field (or equivalent experience).
• Minimum 2 years of experience in related field.
• Experience serving members in the community.
• Health plan experience with case management responsibilities.
• Experience with Medicare/Medicaid programs.
• Experience with vulnerable populations including behavioral health needs.

Responsibilities

• Evaluates member needs via phone or home visits and facilitates care plans.
• Outreach to assess needs and coordinate with providers and resources.
• Develops ongoing care plans for high-acuity members and coordinates with providers.
• Coordinates between members, families, and care teams to ensure access to services.
• Monitors plans and advises on changes based on outcomes.
• Participates in interdisciplinary team meetings and care coordination.
• Ensures compliance with HIPAA and regulatory requirements.

Skills

Behavioral health experience

Medicare/Medicaid experience

Case management

Bi-lingual

Education

Associate degree in behavioral health or related field

Job description

Are you ready for new challenges and new opportunities?

Join our team!

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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 Manager d evelops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

Primary Duties and Responsibilities:

• Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health, substance use and social determinant needs
• May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources.
• Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders.
• Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members.
• Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs
• Participates in Interdisciplinary team meetings as appropriate.
• Facilitates care coordination and collaborates with appropriate providers or specialists to ensure members have timely access to needed care or services.
• Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs.
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Upon notification of a crisis the CM, and CM supervisor, as necessary, shall triage and employ necessary interventions to assist member recover from the crisis. If imminent danger is suspected or present activates emergency services, as necessary and consistent with training and policy.
• Perform tasks that align with and support departmental and organizational objectives.
• Ensures compliance with all state and federal regulations, including HIPAA standards of confidentiality of protected health information, reporting critical incidents and reporting of quality-of-care issues.
• 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.

Requirements:

• Associate’s degree in behavioral health or social work or related field or equivalent combination of education and experience.
• Minimum 2 years of experience in related field.
• Experience with serving members in the community.
• Health plan experience with case management responsibilities.
• Experience with Medicare / Medicaid programs.
• Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, individuals with physical disabilities, housing insecurity, mental health and substance use disorder and other vulnerable needs.
• Previous experience in utilization management, discharge planning and/or housing resources.
• Able to work independently with minimal supervision.
• 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; is 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.
• Possession of valid driver’s license with access to a reliable insured automobile.
• TB Clearance
• First Aid and CPR Certification

Preferred Requirements:

• Bi-lingual in any of the following languages preferred: Ilocano, Tagalog, Mandarin Chinese, Japanese or Korean.
• Ability to communicate using American Sign Language.
• Licensed RN with BH experience, LSW, LCSW, LMFT, LMHC, or LPC in the State of Hawaii.

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: $70,000 - $83,000 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.