Program Manager

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

Benefits offered by this job

Low-cost medical, dental, drug and vision insurance

Paid time-off

401k employer contribution

Referral bonus

Pretax transportation and parking program

Job summary

AlohaCare is seeking a behavioral health program administrator in Honolulu, Hawaii. The role involves providing oversight of behavioral health services to ensure compliance with regulatory standards, monitoring utilization trends, and managing a team. The ideal candidate will have extensive experience in behavioral health, managed care, and team management.

The salary range for this position is $81,000 – $110,000 annually. AlohaCare provides a comprehensive benefits package, including health insurance and participation in the 401k plan.

Qualifications

• Minimum of 5 years in behavioral health/substance use disorder.
• Minimum of 5 years in managed care with accreditation knowledge.
• At least 3 years of team management experience.

Responsibilities

• Provide administrative oversight of the CCS behavioral health program.
• Monitor and process referrals and disenrollment notifications.
• Ensure compliance with quality measures and performance indicators.

Skills

Behavioral health expertise

Managed care knowledge

Team management

Healthcare reporting

Time management

Microsoft Office skills

Job description

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.

Primary Duties and Responsibilities

• Provide administrative oversight of the CCS behavioral health program to ensure compliance with MQD RFP requirements for the program. Maintain awareness and knowledge of key requirements (contractual, regulatory, accreditation) related to behavioral health/substance use services and the reference materials supporting these.
• Monitor referral/disenrollment notifications from MQD. Process referrals and assign newly enrolled members to a case management provider and ensure timely notification of disenrollments to CM providers to ensure transition of care occurs.
• Monitor BH data against key performance measures, including BH PIP, CAHPS, NCQA and other accrediting standards, and develop and implement strategies to support compliance with Behavioral Health quality measures.
• Ensure all CCS program policies and procedures are kept up to date, accurate, and meet contract and compliance requirements.
• Participate in/Lead key MQD/MCO initiatives, including the current BH Performance Improvement Project, and which may include other efforts such as expansion of Medication Assisted Treatment (MAT) services, efforts to widen the implementation of SBIRT services, enhanced collaboration with Hawaii CARES, and as prioritized by AlohaCare and/or MQD. Participate in appropriate MQD workgroups as identified by the CCS BH Director.
• Monitor utilization for key BH and substance use conditions to ensure adequate network and availability of providers, and access/referral to treatment services, and to identify and report on trends and practices that may indicate over‑and under‑utilization of substance use and other BH services.
• Monitor departmental performance measures, compare results against requirements or other established benchmarks, and assist in instituting corrections as necessary.
• Provide consultation, education, and training to providers in conjunction with AlohaCare’s CCS Provider Network Development Department, and provide or arrange for the provision of consultation, education, and training to staff to support the provision of services to CCS members.
• Participate in the Quality Improvement process to ensure that quality care and services are provided to CCS members, including monitoring processes and documentation as well as identifying and researching potential quality of care issues and forwarding information to the QI/Compliance staff as indicated.
• Work closely and in collaboration with the Quality Improvement staff to ensure completion, validation, and timely submission of all required Behavioral Health reports, based on the program’s contractual obligations to the State/MQD, CMS, and any accreditation body/entity (e.g. NCQA).
• Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
• Maintain AlohaCare’s confidential information in accordance with AlohaCare policies, 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.
• Minimum of 5 years of experience working in the behavioral health/substance use disorder field.
• Minimum of 5 years of experience working in the field of managed care, with a strong knowledge of accreditation and quality performance indicators. Must be familiar with HEDIS and other BH quality and accreditation measures.
• Minimum of 3 years of experience managing and developing a team.
• Prior experience working with Medicaid/Medicare populations in a healthcare setting.
• Prior experience with healthcare reporting and compliance.
• Knowledge of local community resources, including specialty care, behavioral health/substance use disorder services, and inpatient/outpatient community resources.
• 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.
• Intermediate skills in Microsoft Programs: Word, Excel, Outlook, and PowerPoint.
• Prior experience using analysis tools or systems (e.g. web‑based, custom, proprietary, etc.).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials, and working directly with end users.

Mental, Physical and Environmental Demands

• 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