Healthcare Consultant I

Job Title: Healthcare Consultant I - North Miami (33012,33013,33014,33015,33167,33147,33142,33150)

Workers will receive mileage reimbursement (from home to members house and back).
Candidate must be located in North Miami, In or around Zip Code 33012 and surrounding areas (33012, 33013, 33014, 33015, 33167, 33147, 33142, 33150)
Must be Bilingual: English/Spanish (fluent in speaking and writing) REQUIRED.

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 8am-5pm EST 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 members 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 members overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to members health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Duties
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
One year Case management experience A MUST
Case Management Certificate Preferred)
Long term care experience (Preferred)

Position Summary
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively
manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Education
Bachelor\'s degree required- No Nurses. Social work degree or related field preferred.

What days & hours will the person work in this position List training hours, if different.
Monday- Friday 8am- 5pm EST