Healthcare Consultant III - Care Management Associate

Job Responsibilities Using care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions. Coordinates and implements Wellness care plan activities and monitors member care needs. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain 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 members to make ongoing independent medical and/or healthy lifestyle choices. Help members actively and knowledgably 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 Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations. Minimum 2 years of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling. Minimum 1 year of experience in MS Office Suite applications, including Word and Excel. Willing and able to travel 10-15% of their time to meet members face to face in their assigned region. Education/Experience Minimum of a Bachelor's degree or a non-licensed master level clinician is required with either degree being in behavioral health or human services field. #J-18808-Ljbffr SGS Consulting