Healthcare Consultant I

Job Responsibilities:

• Develop 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 Coordinator will determine appropriate services and support due to members’ health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.
• Helps members 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.

Skills:

• Case management experience required, long term care experience preferred
• Microsoft Office including Excel competence
• Bilingual Spanish/English Required

Education/Experience:

• Bachelor's degree required
• No nurses
• Social work degree or related field.