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 primary responsibilities of the Aid to Disabled Review Committee (ADRC) Review Nurse are to search for and receive referrals for review of current QUEST Integration members who may qualify for the Aid to Disabled program, or State of Hawaii Organ and Tissue Transplant (SHOTT) program. The ADRC Review Nurse will request, compile, and review documentation to submit referrals to the Department of Human Services for determination and transition to the ABD payment methodology. Maintaining a good rapport with the Department of Human Services’ main contacts and AlohaCare contracted physicians is vital. The ADRC Review Nurse will update actions taken in members’ activity records as well as make necessary updates to members’ programs in Altruista. In addition, the ADRC Review Nurse will collaborate with Centauri for additional referrals and send referrals for those members needing assistance in obtaining Social Security Income. By behavior and work style, the ADRC Review Nurse communicates, coordinates, and collaborates with other AlohaCare staff or external parties that result in outstanding service to our members and their providers.

Primary Duties and Responsibilities:

• Review referrals, member eligibility, benefit coverage, and member qualifications.
• Screen and review internal and external referrals for Medicaid/MQD’s carved out Disability Program through the Aid to Disabled Review Committee (ADRC) process.
• Prepare a complete referral packet for submission to the State/Medicaid office that contains clinical notes and signed MQD-DHS forms.
• Ensures that referral final outcomes have effectuated timely, that is, the effective date of Disability Program (Aged, Blind and Disabled/ABD) in the State Online Eligibility and AlohaCare’s information systems are in alignment with the State’s review decision.
• Screen and review internal and external referrals for the State of Hawaii Organ and Tissue Transplant (SHOTT).
• Submit Centauri referrals.
• Submit the Aid to Disabled Review Committee (ADRC) Report quarterly.
• Provide timely computer entry of encounter information and data to maintain an accurate record of reviews and effective dates to Plan members.
• Use measurements of efficiency and productivity to improve performance.
• Communicate with providers or their staff -- community health centers, private independent practices, hospitals, skilled nursing facilities, rehabilitation therapy clinics, laboratories, and others in a professional manner.
• Respond to telephone messages, e-mails, and other forms of communication in a timely and professional manner.
• Welcome and participate in education and training activities.
• Identify opportunities to improve processes, passing them on to the Manager.
• Learn and develop experience in the use of AlohaCare’s information system, proprietary screening tool, care management system, QNXT and, as necessary, AlohaCare’s historical databases.
• 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, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare.

Requirements:

• Licensed RN or LPN in the State of Hawaii.
• Minimum of 1 year of utilization review experience, or minimum of 2 years of direct patient care experience in a hospital setting.

• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
• Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Professional telephonic etiquette skills.
• Ability to solve problems, analyze, think critically, and make good judgments.
• Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• 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; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Data entry experience with a high degree of accuracy and attention to detail.

• Ability to conduct training with audiovisual presentations.
• 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:

• Minimum of 3 years of inpatient clinical experience.
• State regulatory experience.
• URAC/NCQA and HEDIS exposure to an asset.

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: $75,000 - $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.