Care Navigator

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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.

The primary role of the Care Navigator is to assess and assist actively enrolled low‑risk and unengaged QUEST members with understanding their health care benefits and accessing providers and services. A Care Navigator’s time is spent telephonically reaching out to members to ensure they have access to care from in‑network providers, community resource providers and plan benefits under the direction and in collaboration with the Interdisciplinary Care Team.

• Perform initial outreach to complete welcome calls for newly enrolled QUEST members.
• Schedule and complete required initial and as needed telephonic health risk assessments.
• Provide telephonic support for inbound routine and complex calls received from members and providers via a call center queue.
• Provide member education and assisting with referral coordination and prior authorizations per member needs and eligibility.
• Document in an electronic care management system all assessment information and care management activities.
• Review prior assessments and historical claims to identify any signs of health status changes to assess member’s level of care and/or prior to completing new assessment.
• Assist with completion of eligibility forms required for Long Term Services and Supports (LTSS) services.
• Coordinate, collaborate, and participate with the interdisciplinary care team members including providers, family members, caregivers and community agencies to support members in maintaining or improving their current health status.
• Coordinate and collaborate with the appropriate internal departments as required per member’s needs (e.g., Medical Management, Transition of Care, Disease Management, Care Coordination, Health Coordination, Travel, etc.) and in‑network physicians/providers and community resource providers to facilitate timely access to available and approved services.
• Connect members with Social Determinates of Health (SDoH) needs to Community Resources in their neighborhood or area or utilizing the Unite Us tool.
• Assisting the member with accessing translation services when needed and requested.
• Coordination of daily administrative responsibilities of documents copying, mailings, and faxes.
• Generating daily if not weekly Excel reports for daily work assignments and prioritize assigned duties.
• Meet operational and compliance with due dates for assessments, care plans, and all regulatory required activities.
• Perform tasks that align with and support departmental and organizational objectives
• Performing other duties as assigned by supervisor and/or manager per departmental needs.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as Aloha Care policies and procedures.
• Responsible for maintaining Aloha Care’s confidential information in accordance with Aloha Care policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to Aloha Care data based on the data classification assigned to this job title.
• Minimum of 2 years of work experience in a customer service role, call center environment, and/or with customer facing responsibilities.
• Ability to establish rapport/relationships with members via a telephonic interview which includes gathering information about their medical history and/or…