Healthcare Consultant I

Client max bill rate ***

**** Must put the city, state and zip code they reside in at top of resume. ****

Location: Field & Work from Home. Candidates must reside in Hialeah, FL - (33010, 33012, 33013, 33014, 33015, 33016, 33018). Training will be conducted remotely via Microsoft Teams for approximately 4-6 weeks. Candidate will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes.

Qualifications:
FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule 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 members 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 members overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to members 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 Hialeah - (33010, 33012, 33013, 33014, 33015, 33016, 33018). Training will be conducted remotely via Microsoft Teams for approximately 4-6 weeks.
Candidate will travel approximately 75% of the time within the region seeing members at home, in assisted living facilities and nursing homes.
FLUENT in English / Spanish REQUIRED

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

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 nurses. Social work degree or related field