Risk management analyst Jobs in Honolulu hi

Case Management Manager

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.

Requirements:

• Masters/ bachelor's degree in social work, or a related field or equivalent combination of education and experience.
• Licensed RN, LCSW, LMHC, LMFT, APRN, CSAC or Licensed Psychologist in the State of Hawaii.
• Minimum of 5 years of related work experience.
• 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.
• Excellent interpersonal skills with the ability to communicate with all levels of the organization.
• 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.
• 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 make 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 project s.
• 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.
• 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 or Access Databases, Outlook, and PowerPoin t.
• 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.
• Multilingual preferred.

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 to 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.
• 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

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