Healthcare Consultant I

Our Client, a Retail Pharmacy company, is looking for a Healthcare Consultant I for their Columbus, OH/Remote location.


Responsibilities:

• 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.
• 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

• Minimum 1 year of relevant experience
• Bachelor's degree or non-licensed master level clinician required
• Verifyable High School Diploma or GED Required

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities