Long Term Support Services (LTSS) Support Specialist

Long-Term Support Services (LTSS) Support Specialist

Aloha Care is a local, non-profit health plan serving Hawai`i's low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members.

Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii's third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.

Aloha Care employees have a passion for helping Hawai`i's most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.

Aloha Care's leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

Aloha Care's comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

• Oversee the relationship with Community Care Foster Family Home (CCFFH) providers and Community Case Management Agencies (CCMA) to ensure compliance with contractual requirements and that members residing in HCBS Residential Care settings receive appropriate services.
• Carries the caseload of members delegated to CCMAs and ensures all assessment and service plan information in member's records are accurate and current.
• Interact with CCFFH's, CCMA's, providers, and physician(s) to ensure appropriateness of services. Utilizing knowledge of LTSS and HCBS residential care, interacts with members and providers to determine and respond to appropriateness of service requests for health plan benefits and community resources.
• Interact with members, family, physicians, and other providers.
• Conduct in-person member assessments when CCFFH or CCMA requests for additional fees are requested.
• Apply MQD fee schedule to members' needs and make recommendations to provider requests.
• Conduct monthly multi-disciplinary rounds with Health Coordination, UM, Behavioral Health, Population Officer and Medical Directors on initial or revisions to CCFFH and/or CCMA agreements
• Outreach to CCFFHs and CCMAs for member placement and fee negotiation. Provides follow-up correspondence both telephonically and in writing.
• Coordinate with the Health Coordination and Medical Management team when member needs and acuity levels are not appropriate for CCFFH/CCMA referral or placement, and providers cannot be located.
• Ensure accuracy of electronic database records
• Facilitate access to services and service authorization.
• Monitor and resolve any concerns about service delivery or providers.
• Assist members in transitioning between hospital, nursing facility, CCFFH and other congregate settings to another community-based setting.
• Assist with completion of Self-Direction enrollment packet, assists with member and caregiver training/retraining of EVV system, monitors, and completes follow-up related to Self-Direction caregivers.
• Coordinate with members who have selected self-directed caregivers to provide their HCBS services to ensure understanding of requirements. Supports clarification of training and re-training and resolution…