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QUEST Integration Care Coordinator

3 months ago

Honolulu, Hawaii, United States HICHW Workforce Development Full time

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 plans/care plans.

Minimum Qualifications:


Bachelors degree and three years of case management experienceEffective communication skills and time management skillsExcellent interpersonal, problem-solving, and organizational skillsExhibit cultural sensitivity to people of various ethnic origins and socioeconomic backgrounds.

Ability to problem solve and use critical thinking skills to deal with a variety of unique situations.
Intermediate working knowledge in Microsoft Word and Outlook.
Basic working knowledge in Microsoft Excel and PowerPoint.
Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
Must have valid drivers license, access to an automobile with current license, registration and no-fault insurance.

Duties and Responsibilities:


Manage members that have been assessed by the LTSS, Event Driven Care, or Complex Case Management Case Managers/Health Coordinators to implement members health action plans (HAP)/care plans to ensure timely services are in place.

This may include initiating the process of ADRC, going home plus, self-directed packets, contacting providers (i.e., follow-up for members, making appointments, finding availability to meet HAP/care plan goals), and submitting/following up on precertification requests to medical management department.

Review Health Action Plans/Care Plans to meet RFP requirements. This may be conducted in person, telephone, email, fax, or video.

Manage patient care by establishing and managing efficient and effective relationships between providers, members, and HMSA to ensure timely access to appropriate medical care.

Document on HMSAs electronic record systems that includes meeting NCQA, CMS, and Med-QUEST Division (MQD) requirements/standards.
Advocate and assist members to navigate HMSA and the health care delivery system.
Attend required trainings and then apply to day-to-day work.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
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