Healthcare Consultant I

Case Management CoordinatorLocation: Work from Home. Candidates must reside in North Miami, Aventura, Hialeah or Miramar. Training will be conducted remotely via Microsoft Teams. Candidate will travel approximately 75% of the time within the region seeing members at home, in assisted living facilities and nursing homes. Fluent bilingual (English/Spanish) required - must be fluent speaking and writing. Mileage reimbursement is approved to and from member homes.Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours. We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, 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 member's overall wellness. 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.Position Summary:Determines medical necessity/appropriatenessFacilitates optimal outcomesIdentifies and follow through with continuous quality/compliance opportunitiesMay also include identification of aberrance's and initiation of corrective actionEducates/empowers customers to ensure compliance, satisfaction and promote patient advocacyOptimize total costsImplementation and evaluation of policy based on usage and program directivesEducate/empower colleagues at all levels to enable decision making at most appropriate levelExperience:Case management experience requiredLong term care experience preferredMicrosoft Office including Excel competentEducation:Bachelor's degree required-No nurse, social work degree or related field.