Healthcare Consultant I /Case Manager

Duration: 3+ months contractJob Description:

• We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team.
• 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.

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 Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience:

• Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting—look for direct experience processing PA requests, ideally with commercial or specialty pharmacy, and strong documentation of meeting service level agreements (SLAs) or production targets.
• Demonstrated ability to multitask using multiple technology platforms and clinical resources—seek candidates who highlight comfort with multitasking, proficiency with Microsoft Office (especially Excel and Word), and using multiple clinical and administrative systems at once.
• Strong communication and collaboration skills in cross-functional teams—prioritize resumes that show effective written and verbal communication, experience working with both clinical and non-clinical staff, and handling phone-based interactions with providers and patients.

Note: This role will require 75% travel for face-to-face visits with members in Miami Dade.Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin disability, or status as a protected veteran.AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.