Healthcare Consultant I
About The Position
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues. Determines medical necessity/appropriateness, facilitates optimal outcomes, identifies and follows through with continuous quality/compliance opportunities. May also include identification of aberrances and initiation of corrective action. Educates/empowers customers to ensure compliance, satisfaction and promote patient advocacy. Optimize total costs. Implementation and evaluation of policy based on usage and program directives. Educate/empower colleagues at all levels to enable decision making at most appropriate level.
Requirements
- Case management experience required
- Microsoft Office including Excel competent
- Bachelor’s degree required - No Nurses.
- Social work degree or related field.
- Minimum 1 year of relevant experience in case management.
Nice To Haves
- Long term care experience preferred
- Bilingual Spanish/English
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Effective communication skills, both verbal and written
Responsibilities
- Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
- Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
- Conducts comprehensive evaluation of Members using care management tools and information/data review.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Conducts multidisciplinary review to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
