Healthcare Consultant I - Bradenton

Job Description

Job Description

Telephonic and field visits.
Mileage is reimbursed to and from member homes.
Candidates MUST be located in Bradenton FL zip codes (34221, 34212, 34205)
This role will require 75% travel for face-to-face visits with members in Tampa area.
Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.
Required to be FLUENT in English and Spanish
We are seeking a self-motivated, energetic, detail-oriented, highly organized, and tech-savvy Bilingual (Spanish-English) Case Management Coordinator to join our Case Management team.
Candidates must reside in Bradenton FL zip codes (34221, 34212, 34205 ) - (Hillsborough County) only. This position offers a Monday through Friday schedule from 8:00 AM to 5:00 PM with flexibility and autonomy in coordinating member care.
The Case Management Coordinator is responsible for conducting telephonic and/or face-to-face assessments, developing and implementing care plans, managing a caseload of supportive and medically complex members, and coordinating services to improve health outcomes and overall wellness. Responsibilities include obtaining prior authorizations, coordinating care with PCPs and specialty providers, providing condition management education, conducting medication reviews, and connecting members to community resources and support services. The ideal candidate possesses strong communication, organizational, and problem-solving skills and is committed to delivering high-quality, member-centered care.

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 members 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
One year Case management experience A MUST / Case Management Certificate ( Preferred)
Long term care experience (Preferred)
Microsoft Office including Excel, Outlook- competent
Bilingual - Spanish / English (required)

Position Summary
Candidate must be located in Bradenton FL zip codes (34221, 34212, 34205 ) - (Hillsborough County) only. The candidate must be Bilingual- (Spanish-English)

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.

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

Education
Bachelor's degree required - No nurses. Social work degree or related field preferred.