Exciting Career Opportunities

Description AlohaCare was founded in 1994 and is Hawaii’s only nonprofit health plan serving QUEST and Medicare members. Ranked 78th among the top 250 businesses in Hawaii as listed by Hawaii Business Magazine, we have almost doubled in size over the last 5 years. We currently serve more than 50,000 QUEST members through a network of health care providers on all islands


As a growing organization, we have many career opportunities available:



EXECUTIVE DEPARTMENT
Director of Medicare
AlohaCare is seeking an innovative and dynamic leader who will be able to develop our Medicare product line with the goal of increasing membership in our Medicare plans. In this position, you will be responsible for: Coordinating and overseeing the management of the operations of AlohaCare’s Advantage and Advantage Plus statewide plans, managing the sales department and be responsible for achieving member enrollment goals, assuring compliance with Medicare and URAC standards and regulations, work in collaboration with administrators and Managers to assure daily operations address and incorporate product line specific requirements, serve as a liaison between CMS and the AlohaCare Managers and Staff to clarify and define CMS requirements. Operations include, but are not limited to, functions in the following areas: sales, enrollment, marketing, customer service, provider relations, finance, claims, compliance, information systems, medical and pharmaceutical management, case management, quality improvement, credentialing, and grievance and appeals.
Our ideal candidate should have: A College Degree in a health related field with 5-7 years of managerial experience, 8-10 years in health care/health insurance and 5 years of executive level Medicare Advantage experience or equivalent combination of education and/or experience, a strong background in Medicare regulations, benefits, and product development, experience in managing a sales department, managerial and operations experience, and the ability to interface with government agencies.


CLINICAL OPERATIONS DEPARTMENT
Care Coordinator
The Care Coordinator is responsible for completing comprehensive assessments, individual care  plans, discharge planning and actively managing members’ care in coordination with the Utilization Management staff, the Primary Care Provider, family members, community resources, and the member. Job functions are performed in accordance with requirements of the QUEST contract, the Medicare contract, AlohaCare’s policies and procedures, and URAC accreditation standards. 
Bachelors Degree or higher in a health related field as a health professional; or RN licensure and three (3) years clinical practice experience required. Certification as a Case Manager through a URAC approved entity, managed Care experience, 2-3 years work experience as a case manager in a community setting, proficiency in Microsoft Word and Outlook with basic understanding of and ability to enter data/run reports from Excel or Access databases preferred. Current valid State of Hawaii Drivers License, travel locally on regular basis with occasional inter-island travel, provide training internally and externally as necessary with providers, and community based programs required.


Member Service Navigator
The role of the Member Service Navigator is to assist health plan members in navigating the health care system by coordinating and facilitating access to both covered and non-covered services to achieve optimal health outcomes. Member Service Navigators will educate Medicare plan beneficiaries on various topics to ensure the consumer is making active choices on how their care is shaped and delivered according to their preferences. Member Service Navigators are assigned to members based on Zip Codes. Service Navigation is an active field outreach position with a majority of work time spent on meeting and visiting Medicare plan beneficiaries in their homes, facility settings, and provider offices. Additionally, the Service Navigator interfaces with AlohaCare Provider Relations staff to ensure network providers are being well-serviced. The Service Navigator assists and facilitates coordination or care and referrals to case management, as needed, access and delivery of medical services according to physician orders, and promotes linkages to appropriate community resources, as needed.
Ability to handle multiple tasks ensuring consumer/provider needs and deadlines are met, fluent in other languages desired/Koreanpreferred, bachelor’s Degree or previous equivalent experience preferred, case management and/or outreach experience is preferred, Medicare Program experience knowledge preferred. Valid Hawaii Drivers license and use own registered and insured car required.




At AlohaCare, our philosophy of caring and 'aloha' assures our commitment to providing the best service available to our provider partners, as well as our members. If you have the experience we need in your field and want to become a part of our wonderful team, please apply with us:



If you are looking for new and exciting challenges and want to make a difference in your community please apply for positions directly through our website or you can mail or fax your resume and cover letter to link below (Follow up calls will not be necessary as all COMPLETED resumes will be processed):

Fax: (808) 973-6345

Requirements Please refer to the Job Description to view the requirements for this job