Healthcare Consultant I

DO NOT CROSS SUBMIT CANDIDATES ON S. FLORIDA POSTINGS


Client max BR ***


Location: Work from Home. Candidates MUST reside in North Miami, Aventura, Hialeah or Miramar.
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


FLUENT Bilingual (English / Spanish) REQUIRED - must be Fluent speaking and writing.


Mileage reimbursement is approved to and from member homes.


Candidates MUST reside in North Miami, Aventura, Hialeah or Miramar.


This role will require 50-75% travel for face-to-face visits with members in Miami Dade.
Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday -Friday working schedule, paid holidays, 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 North Miami, Aventura, Hialeah or Miramar.
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


Duties:


Determines medical necessity/ appropriateness
Facilitates optimal outcomes
Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action
Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
Optimize total costs
Implementation and evaluation of policy based on usage and program directives
Educate/empower colleagues at all levels to enable decision making at most appropriate level


Experience:


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


Education:


Bachelor's degree required-No nurse, social work degree or related field.