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Case Manager - Service Coordinator (Oahu)


Posted: 10/2/2019
Job Reference #: 5000475043106

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

To provide case management services for eligible HMSA members and facilitate a collaborative relationship among members, providers, community agencies and HMSA staff in order to ensure members receive timely and integrated access to services across the continuum of care, including supporting and managing member's physical, emotional, social and economic barriers to appropriate medical care.

Position requires ability and allows the flexibility to work primarily from home or in a mobile office environment and to a lesser extent at various unassigned workstations located throughout applicable HMSA department(s) mainly for in-person meetings with internal contacts. Parking validation will be provided on an occasional and transitory basis for approved business needs.

Minimum Qualifications

  1. Associates degree in Nursing or Master's degree in Social Work and a minimum of one year relevant healthcare experience.
  2. Must meet all State of Hawaii certification and licensure requirements for a Social Worker, or Licensed RN
  3. Current, unrestricted RN or social worker license issued by the state of Hawaii or any other license or certification that meets the State requirements of a health care professional.
  4. Strong verbal and written communication skills.
  5. Exhibit cultural sensitivity to people of various ethnic origins and socioeconomic backgrounds.
  6. Effectively prioritize and manage multiple projects and assignments.
  7. Effectively solve practical problems and deal with a variety of unique situations where only limited standardization exists.
  8. Requires safely operating an insured automobile for travel to off-site locations to conduct and accomplish business related activities.
  9. Must have valid driver's license, access to an automobile with current license, registration and no fault insurance.

Duties and Responsibilities

  1. Conduct timely face to face health functional/risk assessments and develop, document, and implement targeted service/care plans based on the results of the assessment for members requiring assistance with care coordination.
  2. Coordinate a team of decision-makers to develop a service/care plan including the PCP, other providers as appropriate, the member, and others determined by the member including family members, caregivers, and significant others in order to ensure timely access to appropriate medical care.
  3. Document and resolve issues for eligible HMSA members and providers on appropriate electronic systems.
  4. Provide continuity of care when members are discharged from a hospital and help them with medication adherence and reconciliation.
  5. Coordinate and monitor activities among internal departments, external community agencies including DHS, Medicare, and the DOH programs excluded from QUEST Integration, as well as HMSA partners/vendors.
  6. Utilize compiled data received from member encounters to assure the services provided meet the member's needs.
  7. Assist Unit Manager in updating or establishing new policies and procedures as needed or identified.
  8. Provide assistance in resolving any concerns about service delivery or providers.
  9. Perform other duties as assigned.