Healthcare Consultant I
Company: US Tech Solutions
Location: Hialeah
Posted on: April 24, 2024
Job Description:
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
- Determines medical necessity/ appropriateness Facilitates
optimal outcomes Identifies and follow through with continuous
quality/ compliance opportunities .
- May also include identification of aberrance's 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 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:
- Case management experience required
- Long term care experience preferred
- Microsoft Office including Excel competent
- Position Summary
- Location: Work from Home. Candidates must reside in Miami Dade
County, FL.
- Training will be conducted remotely via WebEx for approximately
1-2 weeks.
- Candidate will travel approximately 75% of the time within the
region seeing
- Members at home, in assisted living facilities and nursing
homes.
Preferred Qualifications:
Bilingual Spanish/English
Ability to multitask, prioritize and effectively adapt to a fast
paced changing environment
Effective communication skills, both verbal and written
Education
Bachelor's degree required - No Nurses. Social work degree or
related field.
Experience
Minimum 1 year of relevant experience in case management.
Skills:
Social work, Case management, Spanish
Keywords: US Tech Solutions, Miami Beach , Healthcare Consultant I, Healthcare , Hialeah, Florida
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