Case Manager - Healthcare Consultant

JOB DETAILS BELOW:

Job Title:       Healthcare Consultant – Case Manager

Location:       Candidate reside in either Doral or Coral Gables, FL (Remote Field visit)

Hours:            Monday - Friday: 8 am - 5 pm

Pay Rate:      $36/hr. on W2 Travel Mileage Reimbursement

Shift: Monday to Friday 8:00am to 5:00pm

Note: Candidate will be travelling to 50-75% of time due to members facing at home, assisted living facilities and rest 25% will be remote/work from home

Position Summary:

• Training will be conducted remotely via Microsoft Teams 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.

Description:

• The position will require Travel to Members' Homes, Facilities, Nursing Homes up to 50-75%. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently.
• The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to Promote Optimal, Cost-Effective Outcomes.
• Requires an RN with unrestricted active license.

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:

• Case management experience required
• Long term care experience preferred
• Microsoft Office including Excel competent

Required Qualifications:

• Bachelor's degree required - No Nurses.
• Social Work degree or related field.