Healthcare Consultant I

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Must put the city, state and zip code they reside in at top of resume.

Location: Work from Home.Candidates MUST reside in city of Homestead/Florida City (33033, 33032) which is in Miami-Dade County. Training will be conducted remotely via Microsoft Teams for approximately 6 weeks. Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.

Qualifications:FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentEffective communication skills, both verbal and written

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member s overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to member s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Position Summary:

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issuesCandidates must be located in zip codes noted aboveThis role requires 50-75% travel for face to face visits with members.Schedule is Monday

• Friday 08:00 AM to 05:00 PM, standard business hours.

Preferred qualificationsAbility to multitask, prioritize, and effectively adapt to a fast-paced changing environment.Effective communication skills, both verbal and written.Managed Care Experience.Computer proficiency in Microsoft Word, Excel, and outlook required.Case management and discharge planning experience.

Duties:

Coordinates case management activities for Medicaid Long TermCare/Comprehensive Program enrollees. Utilizes critical thinking andjudgment to collaborate and inform the case management process, inorder to facilitate appropriate healthcare outcomes for members byproviding care coordination, support and education for members throughthe use of care management tools and resources. Conducts comprehensive evaluation of Members using care managementtools and information/data review Coordinates and implements assignedcare plan activities and monitors care plan progress Conducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and servicesnecessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximummember engagement and promote lifestyle/behavior changes to achieveoptimum level of healthProvides coaching, information and support to empower the member tomake ongoing independent medical and/or healthy lifestyle choicesHelps member actively and knowledgeably participate with their providerin healthcare decision-making Monitoring, Evaluation and Documentationof Care: Utilizes case management and quality management processes incompliance with regulatory and accreditation guidelines and companypolicies and procedures.

Experience:

Case management experience requiredLong term care experience preferredMicrosoft Office including Excel competent

Education:

Bachelor's degree required

• No Nurses. Social Work degree or relatedfield.