Hiring for Healthcare Consultant in Miami Dade County, FL (33030, 33033, 33031, 33032, 33034)

LanceSoft•Tallahassee, FL

14h•Remote

About The Position

The Healthcare Consultant I/ Care Coordinator coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees. The role assesses, plans, implements, and coordinates case management telephonically and through face-to-face visits to evaluate members’ medical needs and support their overall wellness. The coordinator manages a caseload that includes supportive and medically complex members, develops proactive plans to address issues, and identifies opportunities to improve short- and long-term outcomes through integrated care. The coordinator determines appropriate services and supports based on members’ health needs, including prior authorizations, coordination with primary care providers and skilled providers, condition-management information, medication review, and community resources. The position uses care-management tools and resources to provide care coordination, support, and education, and applies case-management and quality-management processes in accordance with regulatory and accreditation guidelines and company policies and procedures. This work-from-home role is for candidates residing in Miami-Dade County, Florida, in the specified ZIP codes. It involves telephonic work and travel approximately 75% of the time within the region to visit members at home, in assisted living facilities, and in nursing homes; mileage to and from member homes is reimbursed. The remaining work is remote. Training is conducted remotely via Microsoft Teams for approximately four weeks. The schedule is Monday through Friday, 8 a.m. to 5 p.m.

Requirements

Bachelor’s degree in social work or a related field; nurses are not eligible for this position.
Case-management experience.
Bilingual Spanish and English.
Reside in Miami-Dade County, Florida, in one of the listed ZIP codes: 33030, 33033, 33031, 33032, or 33034.
Competence with Microsoft Office, including Excel.
Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment.
Effective verbal and written communication skills.

Nice To Haves

Long-term-care experience.

Responsibilities

Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
Assess, plan, implement, and coordinate case management activities by phone and face-to-face to evaluate members’ medical needs.
Manage a caseload that includes supportive and medically complex members, developing proactive courses of action to address issues and improve outcomes.
Determine appropriate services and supports based on members’ health needs, including prior authorizations, provider coordination, condition-management information, medication review, and community resources.
Use critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes.
Conduct comprehensive member evaluations using care-management tools and information and data review.
Coordinate and implement assigned care-plan activities and monitor care-plan progress.
Conduct multidisciplinary reviews to achieve optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services to meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and promote lifestyle or behavior changes.
Provide coaching, information, and support to empower members to make independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably with their providers in healthcare decisions.
Monitor, evaluate, and document care using case-management and quality-management processes in compliance with applicable guidelines and company policies and procedures.
Visit members at home, in assisted living facilities, and in nursing homes within the region.