Healthcare Consultant I

Location Requirements:

• Candidates must reside in one of these counties: Central/SE Ohio Counties Preferred: Ashland, Richland, Wayne, Fayette, Highland, Ross, Pike, Jackson, Licking, Muskingum, Coshocton, Fairfield, Franklin, Morrow, Washington.
• Candidates could be required to travel to the corporate office in Franklin County for onsite meetings.
• These usually happen 1-2 times a year.

Position Overview:

• This is a full-time field-based telework position, in Ohio.
• This position requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations, up to 50% or more of the time.
• Applicants must reside within the central/SE region of Ohio.
• Monday-Friday 8-5pm with flexibility needed to work later to meet member needs.

Role Summary:

• The Case Management Coordinator 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.
• Must reside in Ohio.

Job 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.

Fundamental Components:

• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

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/behavioral 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.
• Works collaboratively with the members' Child and Family Teams.
• 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.
• Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.

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.

Education:

• Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred.
• (i.e. psychology, social work, marriage and family therapy, counseling, juvenile justice).

Required Experience and Skills:

• 2+ years of experience in behavioral health, social services, or human services.
• 2+ years of experience with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint).
• 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers.
• 2+ years experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• 2+ year of experience with Ohio delivery systems, including local community networks and resources.
• Willing and able to travel within the assigned region up to 50% of the time; Some travel to the New Albany office may be required for trainings/meetings:.
• Reliable transportation required.
• Mileage is reimbursed per our company expense reimbursement policy.
• Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed.

Preferred Qualifications:

• Case management and discharge planning experience.
• Managed Care experience.
• Medicaid experience.