Healthcare Consultant I

Job Title: Healthcare Consultant I
Job Location: Tampa, FL 33624
Job Duration: 3+ Months Contract (Possibilities of Extension)
 
Location:

• Candidates must reside within 2–3 miles of the 33624/33625 zip code.
• Work from Home.
• Candidates must reside in Hillsborough County, FL and live within 2–3 miles of the 33624/33625 zip code.
• Training will be conducted remotely via Microsoft Teams.
• Candidate will travel approximately 75% of the time within the region seeing members at home, in assisted living facilities, and nursing homes.

 
Position Summary:
We are seeking self-motivated, energetic, detail-oriented, highly organized, tech-savvy Case Management Coordinators 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.
The 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 member’s overall wellness.
The 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 member’s overall wellness through integration.
Case Management Coordinators will determine appropriate services and supports due to member’s health needs; including but not limited to:

• Prior Authorizations.
• Coordination with PCP and skilled providers.
• Condition management information.
• Medication review.
• Community resources and supports.

 
Duties:

• Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilize 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.
• Conduct comprehensive evaluation of members using care management tools and information/data review.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Conduct multidisciplinary review to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Help members actively and knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation, and Documentation of Care:

• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

 
Required Qualifications:

• Bilingual Spanish/English.
• Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment.
• Effective communication skills, both verbal and written.

 
Experience:

• Case management experience required.
• Long term care experience preferred.
• Strong in Microsoft Office including Excel.

 
Education:

• Bachelor’s degree required — No nurses.
• Must have a Social Work degree or related field.