Healthcare Consultant I

NO INTERVIEW: THIS WILL BE MANAGER QUICK HIRE AFTER VIEWING THE RESUMES.



Important Skills: Must be proficient with MS Office - with excel, should be comfortable using filters to sort through spreadsheet data.



Outbound call experience is a major plus as these hires will be primarily on outbound calls with members.





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 . 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



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 . 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:



? Minimum 1 year of relevant experience



Education:



High School Diploma/GED