Healthcare Consultant I: Central/Southeast Ohio

Job Description

Job Description

Care Coordinator
Central/Southeast OHIO Counties: Franklin, Ashland, Athens, Coshocton, Delaware, Fairfield, Fayette, Gallia, Guernsey, Highland, Hocking, Holmes, Jackson, Knox, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Vinton, Washington and Wayne.
Candidates could be required to travel to the corporate office in Franklin County for onsite meetings. These usually happen 1-2 times a year.

Job Description:
This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Central/Southeast Ohio to member homes and other requested member locations, up to 50% or more of the time.
Applicants may reside within the Central/Southeast region of Ohio: Franklin, Ashland, Athens, Coshocton, Delaware, Fairfield, Fayette, Gallia, Guernsey, Highland, Hocking, Holmes, Jackson, Knox, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Vinton, Washington and Wayne.
Monday-Friday 8-5pm with flexibility needed to work later to meet member needs.

Business Overview
As part of the bold vision to deliver the Next Generation of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.
The Case Management Coordinator 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. Must reside in Ohio.

Fundamental Components:
Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

Evaluation of Members:
Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Works collaboratively with the members' Child and Family Teams.
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 knowledgably participate with their provider in healthcare decision-making.
Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
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.

Duties
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

Experience
Minimum 1 year of relevant experience

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
Bachelors degree or non-licensed master level clinician required
What days & hours will the person work in this position List training hours, if different.
Mon-Fri 8 AM-5 PM EST