Behavioral Health Assistant Care Coordinator

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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 Opportunity:

The Behavioral Health (BH) Assistant Care Coordinator supports the functions of the BH/CIS and TOC Program Managers and BH Director by assisting with the Care Coordination activities associated with the BH CCS and SEBD program carve out monitoring, CIS claims review and monitoring, and specific BH resource management, i.e. ABA service provisions and providers.

In addition, the Behavioral Health (BH) Assistant Care Coordinator assists in the compilation of data for QI, HEDIS, and MQD reporting, as needed. Job functions are performed in accordance with requirements of the State’s DHS-Med-QUEST Division, CMS Medicare requirements, Aloha Care’s policies and procedures, and NCQA standards.

Primary Duties and Responsibilities:

• Assist with referrals and preparation of documents necessary for disability determination or to the specialized programs such as the SEBD program administered by the CAMHD, or to the Community Care Services (CCS) program.
• Assist with the creation of the authorization of shells and process as required.
• Follow up with members who are discharged from the Child and Adolescent Mental Health Division (CAMHD) and who are returned to our base plan for BH services.
• Follow up with the members who no longer meet the criteria for additional and intensive behavioral health services from the CCS program, and who are transitioned back to the base plan for BH services.
• Keep abreast of community resources for alternative health care, support services, social services and recreational services that may be appropriate for the QUEST Integration and Medicare BH members. Compile and maintain resources for ease of use by Clinician/Care Coordinators.
• Assist Clinician/Care Coordinators/Housing Coordinators in the identification of appropriate community resources.
• Coordinates with MM, CS, SC, TOC, Pharmacy, and TCSS, any other internal departments, the authorizations and physician orders for entry into G7 or QNXT, under the direction of a Clinician/Care Coordinator/Housing Coordinator.
• May do some member, PCP, and provider contacts under the supervision of the Clinicians/Supervisor or Manager.
• Prepare and coordinate letters/correspondences to members, PCPs, and providers as requested by the Clinicians/ Supervisor/Manager.
• Assist the Supervisor/Manager in generating and monitoring utilization (UM) reports, BH reports, member service reports, HEDIS, QI reports, and claims resolutions.
• Participate in staff meetings and trainings, take minutes/attendance, and post on BH Share Point.
• Assist in the maintenance of Program related materials received from providers, as well as educational materials.
• Assist the department with claims review and or denial reconciliation when requested.
• 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…