Healthcare Consultant I - North Miami-Dade County, FL

Candidates must be located in North Miami Dade county

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.

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.



Position Summary:



Location: Work from Home
Candidates must reside in North Miami Dade County, FL.

Training will be conducted remotely via Microsoft Teams for approximately 2-4 weeks.

Candidate will travel approximately 75% of the time within the region seeing

Members at home, in assisted living facilities and nursing homes
Preferred Qualifications:

Bilingual Spanish/English

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Effective communication skills, both verbal and written



Duties:



Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.

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.

Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress, Conducts multidisciplinary review 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 knowledgeably 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.



Experience:



Case management experience required

Long term care experience preferred

Microsoft Office including Excel competent



Education:



Bachelor's degree required - No nurses
Social work degree or related field.









What days & hours will the person work in this position? List training hours, if different






Bachelor's degree required - No nurses
Social work degree or related field











Is this an in-person, patient-facing role?





Yes






Onsite Requirements





Fully remote (never coming onsite)