Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues. Candidates must be located in mid Miami (IN ONE OF THE ZIP CODES: ( 33010, 33012, 33013, 33014, 33015, 33016, 33142, 33147, 33127, 33125, 33185, 33193, 33196 ).
Numbers & Facts
Location
Miami, FL
Job Type
Temporary, Full-time
Salary
$35–$36 Per Hour
Company Size
51 - 200
Year Founded
null
Headquarters
Princeton, NJ, US
Website
https://sgsconsulting.com/
Description
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
Candidates must be located in mid Miami (IN ONE OF THE ZIP CODES : (33010, 33012, 33013, 33014, 33015, 33016, 33142, 33147, 33127, 33125, 33185, 33193, 33196)
This role will require 50-75% travel for face-to-face visits with members in Miami Dade County area.
FLUENT Bilingual - Spanish / English (required)
Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours
Job 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.
Qualifications
One year Case management experience a must Case Management Certificate {Preferred)