Healthcare Consultant II

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues



Determines medical necessity / appropriateness

Facilitates optimal outcomes

Identifies and follow through with continuous quality/ compliance opportunities .

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 members at all levels to enable decision making at most appropriate level

Complete transition of care protocol and follow up which includes a post discharge assessment and care plan updates



Position Summary:



Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively

manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues



Duties:



Determines medical necessity/ appropriateness

Facilitates optimal outcomes

Identifies and follow through with continuous quality/ compliance opportunities .

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

Complete transition of care protocol and follow up which includes a post discharge assessment and care plan updates



Experience:



- Minimum 2 years of clinical experience

- RN with unrestricted Ohio or compact license

- Effective communication skills, both verbal and written

- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment



Education:



Minimum of an associated degree in nursing

RN license that is active and unrestricted in Ohio or compact state