Healthcare Consultant III

MUST HAVE:
IL resident who lives in/near one of the counties listed below and is interested in doing field case management with the elderly and individuals with disabilities who are approved for in-home or nursing facility care. We have 2 positions total, one per county/counties. ***On each resume, please clearly list which county/counties the candidate is applying for.***

1. Whiteside/Henry Counties
2. Winnebago County

Position will require travel to members' homes. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently.

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 Field Case Management Coordinator utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Experience with case management is preferred.

Position Summary:

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support 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 member s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member s 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 member s 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 experience preferred
2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred

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.)