DSNP 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 Dual Eligible Special Need Plan (D-SNP) Care Navigator is to assess and assist actively enrolled low-risk and unengaged D-SNP members with understanding their health care benefits and accessing providers and services. The majority of the D-SNP 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 D-SNP members.
• Schedule and complete required initial and annual telephonic health risk assessments (HRA) for D-SNP members as required by regulatory agencies.
• Create initial and update Care Plan for D-SNP members after HRA completion as required by regulatory agencies.
• Engage members/providers to participate in the assessment process and collaboratively develop a person-centered Care Plan for each D-SNP member as required by regulatory agencies.
• Implement Care Plan by executing planned intervention(s) as directed, which include but are not limited to facilitating timely access to services, addressing barriers to care and medications, identifying and providing transportation assistance, if needed, etc., on behalf of the member and provider.
• Conduct Care Plan or Health Action Plan reviews with members as required to monitor and document the Member’s progress of goals and services in their Care Plan or Health Action Plan.
• Assist with completion of eligibility forms required for Long Term Services and Supports (LTSS) services.
• Meet operational and compliance with due dates for assessments, care plans, and all regulatory required activities. Provide telephonic support for inbound routine and complex calls received from D-SNP members and providers via call transfer.
• Provide D-SNP member education and assist 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 D-SNP member’s level of care and/or prior to completing new assessment.
• 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 D-SNP member’s needs (e.g., Medical Management, Transition of Care, Disease Management, Care Coordination, Service Coordination, Travel, etc.) and in network physicians/providers and community resource providers to facilitate timely access to available and approved services.
• Assist the member with accessing translation services when needed and requested.
• Connect members with Social Determinates of Health (SDoH) needs with any Community Resources in their neighborhood or area or utilizing the Unite Us tool.
• Performs tasks that align with and support departmental and organizational objectives.
• Generate daily if not weekly Excel reports for daily work assignments and prioritize assigned duties.
• All…