Healthcare Consultant I

Healthcare Consultant IOur client, a Retail Pharmacy company, is looking for a Healthcare Consultant I for their Mid Miami, FL location.Responsibilities: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 member's 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 member's overall wellness through integration.Case Management Coordinators will determine appropriate services and supports due to member's health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.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 reviewCoordinates and implements assigned care plan activities and monitors care plan progressConducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of healthProvides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choicesHelps 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.Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issuesRequirements:FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentEffective communication skills, both verbal and writtenWe are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team.Verifyable High School Diploma or GED RequiredOne year Case management experience A MUST Case Management Certificate (Preferred)Long term care experience (Preferred)Microsoft Office including Excel competent ** Bilingual - Spanish / English (required)Managed Care experienceComputer proficiency in Microsoft Word, Excel, and Outlook requiredCase management and discharge planning experienceBachelor's degree required - No nurses. Social work degree or related field preferred.Why Should You Apply?Health BenefitsReferral ProgramExcellent growth and advancement opportunities