Transition of Care Specialist I HMSA

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets. Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member...

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets.Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member...

CUSTOMER EXPERIENCE Provide all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members and other...

CUSTOMER EXPERIENCE Provide all customers with an exceptional customer-focused and positive HMSA Center experience. Ensure that the experience meets the customer's needs and exceeds their expectations. Communicate and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members and other...

Assists with and/or performs operational quality measures as assigned for limited lines of business and document errors with assistance by: Applying basic knowledge of HMSA's benefits and their application Reviewing provider contracts/rates and compare them to "Plan Benefits" to ensure that HMSA's payment or denial agrees with both the provider contract...

CUSTOMER INTERACTIONDeliver an outstanding customer-centric experience at the HMSA Center. Strive to meet and surpass customer expectations while effectively communicating HMSA's dedication to service excellence.Foster lasting relationships with HMSA's members and other consumers by acting as their reliable advisor, ensuring commitments are...

Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as assigned by management independently. Independently be able to ensure Provider Operations' needs are addressed; must be able to clearly articulate business needs so that the department is not...

Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as assigned by management independently. Independently be able to ensure Provider Operations' needs are addressed; must be able to clearly articulate business needs so that the department is not...

Engagement, Assessment and Planning Engages members with the Event Driven Care program (outreach and successful enrollment) in facilities and other settings using system generated alert, census data or other sources which identify that patient have been admitted in the hospital, or registered in the Emergency Department, and their relative risks for...

Job Summary: Hybrid Work Environment - Must reside on Oahu To provide care coordination for eligible HMSA members and facilitate a collaborative relationship among members, providers, community agencies and HMSA staff to ensure members receive timely and integrated access to services. Case Managers/Health Coordinators with Implementing the health action...

Quality Improvement LeadershipLead and oversee HMSA's comprehensive Quality Improvement initiatives, ensuring alignment with accreditation, regulatory, and program standards (e.g., NCQA, Med-QUEST, CMS, OPM, etc.). Direct project teams and provide expert guidance throughout the phases of planning, development, execution, and assessment to guarantee that...

Monitor, track and analyze legislation introduced at the state levelGenerate weekly Executive Summary Report of key legislation. Develop and distribute weekly updates to HMSA executive staff throughout the legislative session. Monitor legislative hearings and meetings as needed. Conduct legislative research and compile summary reports on state and national...

Monitor, track and analyze legislation introduced at the state levelGenerate weekly Executive Summary Report of key legislation. Develop and distribute weekly updates to HMSA executive staff throughout the legislative session. Monitor legislative hearings and meetings as needed. Conduct legislative research and compile summary reports on state and national...

Conduct timely face to face assessments and develop, document, and implement targeted health action plans/care plans based on the results of the assessment for members requiring assistance with care coordination. Coordinate a multi-disciplinary team to develop a person- centered care plan to include but not limited to member's PCP, other service providers as...

Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by:Researching and collaborating with other units or departments to find a solutionAccurately updating member recordsContacting external partners who provide services...

Find out if this opportunity is a good fit by reading all of the information that follows below.aProject management and facilitation Develops and maintains project plans, timelines, and scope documents for strategy initiatives.Proactively manages deliverables, timelines, and budget:Monitors and takes appropriate action to ensure various task and...

Facilitates department workflow by supporting clinical team with administrative care coordination support. Locates community services and other referral locations for enrollees, arranges access to care, supports communication with hospitals, and providers. Provides non-clinical support to workflows involving utilization management, case management, disease...

Position OverviewCompensation Range: $51,124- $74,293 In alignment with the mission and vision of HMSA, this role is dedicated to the design and implementation of impactful training initiatives for the Customer Relations team. The focus will be on identifying departmental needs and addressing skill gaps through tailored coaching and consulting.Essential...

Job Summary Works independently to lead provider negotiations and projects that include the Clinical Integration Division, Health Management Operations, Finance Division, and Executive Leadership and management. Provide comprehensive statistical analysis from multiple sources that support corporate strategies and initiatives for all Lines of Business. ...

Responsible for all aspects of the quality program for a business unit within a Strategic Business Unit (SBU) including strategic planning, program development and leadership, and staffing. Serves as a member of the management team in designing, implementing, and monitoring quality operations with well defined processes and uses performance measurement as...