Apply online at http://www.alohacare.org/Careers/Default.aspx
The Company:
AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors, and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.
The Culture:
AlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.
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 Program Manager provides administrative oversight of the Behavioral Health program and coordinates program activities to ensure compliance with MQD contract requirements, ensure compliance with AlohaCare policies and procedures, and to ensure compliance with requirements/standards set by DHS, CMS, and NCQA; provides leadership for and works closely with Quality/Compliance teams to ensure compliance with Performance Improvement Projects; works closely with QI/Compliance teams to ensure that behavioral health quality measures are monitored, and interventions are established in order to meet or exceed HEDIS and other quality measures, and to ensure NCQA accreditation standards for the CCS program are met.
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. Participates 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.
- Monitors departmental performance measures, compare results against requirements or other established benchmarks, and assist in instituting corrections as necessary
- Provides consultation, education, and training to providers in conjunction with AlohaCare’s CCS Provider Network Development Department, and provides or arranges for the provision of consultation, education, and training to staff to support the provision of services to CCS members.
- Participates 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.
- Works 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).
- Provide behavioral health representation at the Inter-disciplinary department team meetings or Inter-disciplinary care team meetings, as well as other ad-hoc meetings or organizational workgroups, as needed.
- All other duties as 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, 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:
- Bachelor’s degree in social work or another closely related field or related field or equivalent combination of education and experience.
- 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.
- Knowledgeable of local community resources, including specialty care, behavioral health/substance use disorder services, and inpatient/outpatient community resources.
- Achieves results, builds trust, communicate effectively, customer and quality focused.
- Excellent interpersonal skills with the ability to communicate with all levels of the organization.
- Strong 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.
- Ability to organize, coordinate, and supervise large projects in a timely, creative, and effective manner.
- Ability to solve problems, analyze, think critically, make good judgments and fair decisions.
- Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.
- Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.
- 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.
- Demonstrated strong skills in providing solutions and/or trouble shooting complex issues.
- Excellent leadership, communication, and analytical skills.
- Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
- Intermediate skills in Microsoft Programs: Word, Excel, Outlook, and PowerPoint.
- Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
Preferred Requirements:
- Prior experience using analysis tools or systems (ex. 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:
- Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
- In an office working environment.
- 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.
