Care Manager, Medicare Stars

HMSA•Honolulu, HI

1d•Hybrid

About The Position

This role focuses on managing Medicare Stars, involving comprehensive assessments, care planning, and delivery to identify and address member needs and care gaps. The position requires strong analytical, communication, and organizational skills, with a focus on quality improvement and leadership. The Care Manager will work with members and families to develop actionable care plans, ensure clear communication with providers, and maintain patient privacy.

Requirements

At least three years of relevant clinical experience in medical-surgical, community or home health care, or equivalent experience in reviewing members' medical care and services.
Must meet facility specified health screening/annual competency requirements.
Demonstrates thorough expertise in care transitions with little supervision required.
Possesses strong documentation and research abilities.
Can analyze information, make decisions, and communicate effectively both verbally and in writing.
Displays interpersonal skills, resolves conflicts, and acts with integrity.
Highly organized, able to multitask independently, fostering adaptability and teamwork.
Performs well in a fast-paced setting and readily adapts to changes.
Delivers outstanding customer service to both internal and external clients.
Utilizes excellent analytical and critical thinking to evaluate medical necessity and the suitability of patient services and treatment individually.
Safeguards patient privacy in accordance with Federal (HIPAA), organizational, and departmental regulations.
Clearly communicates with providers and health care teams while building collaborative relationships.
Intermediate working knowledge in Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
Experience with electronic medical records.
Valid current Hawaii Registered (RN) or Registered Pharmacist (RPh).
Reliable transportation to perform in person (Face to Face) meetings with members in their home or in alternative settings.

Responsibilities

Conduct comprehensive assessments, including physical, psychosocial, and health literacy evaluation.
Interpret diagnostic data to identify member and family needs.
Analyze complex cases and complete medication reconciliation post-discharge.
Determine underlying causes contributing to high costs.
Develop individualized transition/treatment plans and address gaps in care delivery.
Partner with and empower members to develop actionable care plans.
Follow through on essential tasks and complete them within required timeframes to close care gaps.
Communicate results to internal and external departments and business partners.
Assess educational needs of members and families and provide clear information.
Engage in quality improvement initiatives.
Support leadership in system-level improvements.
Analyze dashboard data for program enhancement.
Mentor new staff to promote best practices.
Perform all other miscellaneous responsibilities and duties as assigned or directed.