HRSN Community Partnerships Specialist

• HRSN Provider Onboarding, Education & Network Support

• Serves as the day-to-day point of contact for HRSN providers and community-based organizations participating in or preparing to participate in HRSN service delivery.

• Supports provider onboarding into HMSA's network, including coordination with internal teams for contracting, credentialing, provider enrollment, administrative setup, and operational readiness.

• Develops, coordinates, and delivers provider education related to HRSN program requirements, workflows, documentation expectations, referrals, authorizations, billing, claims, invoices, and reporting.

• Provider, Member & Referral Coordination and Issue Resolution

• Maintain provider capacity logs and coordinate assignment of members to HRSN providers when a provider is not specified on the referral or authorization form; or if specified provider has reached servicing capacity

• Researches and coordinates resolution of day-to-day HRSN provider issues, including questions related to referrals, service eligibility, documentation, authorizations, billing, claims, payment, and program workflows.

• Coordinates member and referral-related inquiries received through internal and external channels to reduce access barriers and support timely connection to covered HRSN services.

• Works with HRSN Program leadership, utilization management, claims, provider operations, analytics, customer relations, and community partners to identify root causes and implement practical solutions.

• Community Stakeholder Engagement & Program Implementation Support

• Builds and maintains collaborative relationships with HRSN providers, community stakeholders, and external partners to support implementation of medical respite, nutrition supports, reentry services, housing supports, CIS/CIS+, and other HRSN benefits as applicable.

• Supports HRSN convenings, workgroups, trainings, and provider feedback loops to identify operational barriers and improve workflows as program guidance evolves.

• Coordinates with internal teams to ensure provider and community feedback informs program design, workflow refinement, communication materials, and rapid-cycle improvement.

• Provider Monitoring, Documentation & Compliance Support

• Supports required provider monitoring activities, including annual on-site visits for medical respite providers when applicable.

• Maintains documentation of provider outreach, education, issue resolution, monitoring activities, and follow-up actions to support MQD expectations, audit readiness, and program integrity.

• Escalates trends, risks, and unresolved barriers to HRSN Program leadership and supports corrective action tracking when needed.

• Performs all other miscellaneous responsibilities and duties as assigned or directed.

#LI-Hybrid

• Bachelor's degree and four years of related experience in healthcare, Medicaid managed care, provider relations, community engagement, program operations, care coordination, social services, or a related field.
• Experience coordinating with providers, community-based organizations, members, or internal business partners to resolve operational issues and support program implementation.
• Strong relationship-building, communication, facilitation, and issue-resolution skills; ability to work effectively with providers, community organizations, members, internal teams, and government partners.
• Ability to communicate program requirements, workflows, and operational expectations clearly to external stakeholders with varying levels of Medicaid experience.
• Working knowledge of regulated healthcare program requirements, provider operations, documentation standards, referrals, authorizations, billing, claims, and compliance expectations.
• Good working knowledge of Microsoft Office applications to include Word, Excel, PowerPoint, and Outlook.
• Ability to maintain provider trackers, issue logs, outreach documentation, meeting materials, and implementation status updates.

Hybrid Work Environment - Must reside in Hawaii

Pay Range: $53,000 - $99,000, position is eligible for an incentive bonus

Note: Individuals typically begin between the minimum to middle of the pay range

The HRSN Community Partnerships Specialist provides dedicated provider, community stakeholder, and member-facing coordination support for Health-Related Social Needs (HRSN) programs implemented under Hawai'i's QUEST Integration Section 1115 Demonstration. The role serves as a key operational bridge between HMSA, HRSN providers, community-based organizations, internal business areas, and the Med-QUEST Division (MQD) to support timely benefit implementation and reduce barriers to member access.

This position supports HRSN provider onboarding, education, contracting and credentialing coordination, day-to-day issue resolution, required provider monitoring activities, and member or referral-related inquiries. The role helps enable community providers and stakeholders to deliver HRSN services effectively while coordinating with internal teams to support accurate payment, compliant documentation, consistent workflows, and sustainable program operations.