Healthcare Consultant I - Ohio

Job Responsibilities:

• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care: 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 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. Help members 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.

Skills:

• The Care Management Associate (CMA) role is a full-time remote telework position. Qualified candidates must reside in Ohio. Candidates must have a private location to complete all work that is free from distractions or other individuals. You will need to secure your own internet but, your equipment will be provided to you prior to your first day.
• Recent experience working for other MCOs, specifically within the last 5-7 years in the state of Ohio. Experience may be replaced with recent employment with healthcare organizations or companies. Must be able to pass the CANS assessment and obtain certification within 90 days of employment.

Education/Experience:

• HS Diploma, GED or Equivalent Experience