Healthcare Consultant III

Safety Sensitive
non clinical role, 1 opening

Field Position - will be both in the field and telephonic. Traveling to member homes and facilities. Mileage is reimbursable.

Coverage Area: Southside/Westside Chicago
We want someone who is organized, efficient, and can work independently.

Questionnaire:
Put city/state at the top of the resume
Must have a dedication quiet place to work with no distractions due to HIPPAA.
Must be hard wired into the modem, WiFi connections is not acceptable, the candidate will need to provide an Ethernet Cord so they can be hard wired into the modem.
Candidates must have strong computer skills.
Strong knowledge of MS Office Suite (Word, Excel, Outlook and TEAMS)


MUST HAVE:
Bachelor's degree in behavioral health or human services REQUIRED (psychology, social work, marriage and family therapy, nursing, counseling, etc.) or non-licensed masters-level clinician.

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources

Position Summary:

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources

Duties:

Evaluation of Members:
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- 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 programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order 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 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.

Experience:

Case management and discharge planning experience preferred
2-3 years experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently
Proficiency with standard corporate software applications, including MS Word, Excel,
Outlook and PowerPoint, as well as some special proprietary applications.
Efficient and Effective computer skills including navigating multiple systems and keyboarding

Education:

Bachelor's degree REQUIRED or non-licensed master-level clinician, with degree being in behavioral health or human services (psychology, social work, marriage and family therapy, nursing, counseling, etc.)