Health Coordinator, RN or SW

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 Health Coordinator is responsible for conducting face-to-face assessments, developing individualized health action plans, interacting with members, providers, and physicians to coordinate primary, acute, behavioral, and long-term services and support (LTSS) for individuals having special health care needs. 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: Conducts face-to-face or virtual (video chat) Health and Functional Assessments (HFA) for all Special Health Care Needs, Expanded Health Care Needs, Long-Term Services and Supports, Community Integration Service Needs, or Community Care Service Needs members on an annual or more frequent basis (as applicable) and a Level of Care Assessment (DHS Form 1147) for members needing long term care. Engages member/providers to participate in the assessment process and collaboratively develop a person-centered Health Action Plan for each member, based upon the HFA, DHS-1147, or other assessments. Ensures the Health Action Plan is a person-centered individualized plan that is developed with the Member and/or authorized representative, is based on an assessment and developed within no more than 30 calendar days of completion of the assessment. Interacts with members, family, physician(s), and other providers utilizing clinical and social knowledge and expertise to determine the member�s current status and capacity and to assess the options for service delivery including use of health plan benefits and community resources to update a Member�s Health Action Plan. Meets with members at a minimum every 90 days in-person or via video chat to monitor and document the Member�s progress of goals and services in the Health Action Plan. Screens for social risk factors and incorporate information on the results of positive screens into clinical decision making and offer screened members interventions to mitigate the impa…