Healthcare Consultant I - North Miami (33012)

Repost of previously approved ClientJP00103775. Do not submit candidates that were rejected for not meeting requirements.


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 (33010,33013,33014,33015,33016)

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.

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.

Candidates must be located in South Miami.
This role will require 50-75% travel for face-to-face visits with members in Miami Dade.
Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.


Preferred Qualifications
Ability 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 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 members 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)
**Microsoft Office including Excel competent
** Bilingual - Spanish / English (required)

Education:

Bachelor's degree required - No nurses.
Social work degree or related field preferred.