*Healthcare Consultant III - Care Manager KY Jefferson County
CTC
Job Summary (List Format)
Location: Jefferson County, Louisville, Kentucky (Must reside in Jefferson County)
Position: Intensive Case Manager (Field Position)
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Key Responsibilities:
- Provide intensive case management to support and facilitate improved healthcare outcomes for members.
- Use critical thinking and professional judgment for advocacy, collaboration, coordination, support, and education.
- Conduct face-to-face visits with members in homes, schools, hospitals, doctor's offices, and other community settings.
- Travel regionally in-state 80-90% of the time; reliable transportation required.
- Attend meetings and training sessions at the Louisville office.
- Assess members' needs using care management tools and data to resolve care needs and maintain optimal health.
- Identify high-risk factors and implement proactive support interventions.
- Develop and monitor wellness care plans for members.
- Collaborate with case managers, supervisors, and medical directors to overcome barriers and achieve optimal outcomes.
- Present complex cases for multidisciplinary review.
- Identify and escalate quality of care issues as needed.
- Negotiate and secure appropriate healthcare services and options for members.
- Use motivational interviewing and influencing skills to engage members and promote positive lifestyle/behavior changes.
- Provide coaching and support to empower members in healthcare decision-making.
- Ensure compliance with regulatory and accreditation standards through proper documentation and quality management processes.
- Determine medical necessity and appropriateness of services.
- Optimize total healthcare costs and implement policy directives.
- Educate and empower both customers and colleagues for better decision-making and advocacy.
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Required Qualifications & Skills:
- Minimum of 5 years' relevant experience.
- At least 6 months' experience in Foster Care, juvenile justice, adoption, behavioral health, trauma-informed care, crisis intervention, or similar areas related to Kentucky SKY populations.
- At least 2 years' experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Minimum 1 year experience with MS Office Suite (Word & Excel).
- Must reside in Jefferson County and be willing to travel 80-90% regionally for face-to-face member meetings.
- Flexibility to work outside core business hours (occasional evenings).
---
Preferred Qualifications:
- 3+ years' experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Experience with Managed Care Organizations (MCO).
---
Education:
- Bachelor's degree in a relevant field required.
---
Schedule:
- Monday to Friday, 8:00 am 5:00 pm EST, with flexibility up to 7:00 pm as needed.
---
Additional Notes:
- City, State, and County must be listed at the top of resume.
- Focus on serving children and families; after-school and after-work hours may be required.
- Emphasis on quality improvement, compliance, cost optimization, and member empowerment.
Location: Jefferson County, Louisville, Kentucky (Must reside in Jefferson County)
Position: Intensive Case Manager (Field Position)
---
Key Responsibilities:
- Provide intensive case management to support and facilitate improved healthcare outcomes for members.
- Use critical thinking and professional judgment for advocacy, collaboration, coordination, support, and education.
- Conduct face-to-face visits with members in homes, schools, hospitals, doctor's offices, and other community settings.
- Travel regionally in-state 80-90% of the time; reliable transportation required.
- Attend meetings and training sessions at the Louisville office.
- Assess members' needs using care management tools and data to resolve care needs and maintain optimal health.
- Identify high-risk factors and implement proactive support interventions.
- Develop and monitor wellness care plans for members.
- Collaborate with case managers, supervisors, and medical directors to overcome barriers and achieve optimal outcomes.
- Present complex cases for multidisciplinary review.
- Identify and escalate quality of care issues as needed.
- Negotiate and secure appropriate healthcare services and options for members.
- Use motivational interviewing and influencing skills to engage members and promote positive lifestyle/behavior changes.
- Provide coaching and support to empower members in healthcare decision-making.
- Ensure compliance with regulatory and accreditation standards through proper documentation and quality management processes.
- Determine medical necessity and appropriateness of services.
- Optimize total healthcare costs and implement policy directives.
- Educate and empower both customers and colleagues for better decision-making and advocacy.
---
Required Qualifications & Skills:
- Minimum of 5 years' relevant experience.
- At least 6 months' experience in Foster Care, juvenile justice, adoption, behavioral health, trauma-informed care, crisis intervention, or similar areas related to Kentucky SKY populations.
- At least 2 years' experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Minimum 1 year experience with MS Office Suite (Word & Excel).
- Must reside in Jefferson County and be willing to travel 80-90% regionally for face-to-face member meetings.
- Flexibility to work outside core business hours (occasional evenings).
---
Preferred Qualifications:
- 3+ years' experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
- Experience with Managed Care Organizations (MCO).
---
Education:
- Bachelor's degree in a relevant field required.
---
Schedule:
- Monday to Friday, 8:00 am 5:00 pm EST, with flexibility up to 7:00 pm as needed.
---
Additional Notes:
- City, State, and County must be listed at the top of resume.
- Focus on serving children and families; after-school and after-work hours may be required.
- Emphasis on quality improvement, compliance, cost optimization, and member empowerment.
Vacancy posted more than 2 months ago
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