Healthcare Consultant I

Job Description:

• We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team.
• This opportunity offers a competitive salary and full benefits.
• Our organization promotes autonomy through a Monday -Friday working schedule, paid holidays, 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 member's 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 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:

• 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.

Education:

• Bachelor's degree required - No nurse, social work degree or related field.

Experience:

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

Location:

• Work from Home. Candidates must reside in North Miami, Aventura, Hialeah or Miramar.
• 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.
• FLUENT Bilingual (English / Spanish) REQUIRED - must be Fluent speaking and writing.
• Mileage reimbursement is approved to and from member homes.
• Candidates MUST reside in North Miami, Aventura, Hialeah or Miramar.
• This role will require 50-75% travel for face-to-face visits with members in Miami Dade.
• Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.