Healthcare Consultant I

DO NOT SUBMIT CANDIDATES WHO WERE ALREADY REJECTED BY THIS TEAM OR SUBMITTED TO ANOTHER ACTIVE POSTING.

**** Must put the city, state and zip code they reside in at top of resume. ****


Location: Work from Home.
Candidates MUST reside in city of Cutler Bay (33157, 33197) which is in Miami-Dade County. Training will be conducted remotely via Microsoft Teams for approximately 4-6 weeks. Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.


Qualifications:
FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written


We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule 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 Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops 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 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:


Location: Work from Home. Candidates must reside in Miami Dade
County, FL (Cutler Bay, 33157, 33197). Training
will be conducted remotely via Microsoft Teams for approximately 4-6
weeks.
Candidate will travel approximately 75% of the time within the region
seeing
Members at home, in assisted living facilities and nursing homes.
FLUENT Bilingual Spanish/English REQUIRED


Preferred Qualifications:
Ability to multitask, prioritize and effectively adapt to a fast paced
changing environment
Effective communication skills, both verbal and written


Duties:


Coordinates case management activities for Medicaid Long Term
Care/Comprehensive Program enrollees. Utilizes critical thinking and
judgment to collaborate and inform the case management process, in
order to facilitate appropriate healthcare outcomes for members by
providing care coordination, support and education for members through
the use of care management tools and resources.
Conducts comprehensive evaluation of Members using care management
tools and information/data review Coordinates and implements assigned
care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
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 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.


Experience:


Case management experience required
Long term care experience preferred
Microsoft Office including Excel competent


Education:


Bachelor's degree required - No Nurses. Social Work degree or related
field.