Healthcare Consultant I

Job Title: Healthcare Consultant I
Location: Work from Home (Candidates must reside in Miami-Dade County, specifically Doral or Coral Gables)
Training: Remote via Microsoft Teams, 4–6 weeks
Travel: ~75% within the region to members’ homes, assisted living facilities, and nursing homes
Duration: 3 Months+ (Possible Extension)

Schedule: Monday–Friday, standard business hours; flexibility required
 
Position Summary:
The Case Management Coordinator is responsible for coordinating care for Medicaid Long Term Care/Comprehensive Program enrollees. This includes telephonic and in-person assessments, care planning, implementation, and monitoring. The role ensures members’ overall wellness by addressing medical, supportive, and complex care needs, and by coordinating services with providers and community resources.
 
Key Responsibilities:

• Coordinate case management activities for assigned members
• Conduct comprehensive member evaluations using care management tools and data
• Implement and monitor care plans, including prior authorizations, PCP coordination, condition management, medication review, and community support
• Facilitate multidisciplinary reviews to ensure optimal outcomes
• Identify and escalate quality of care issues through established channels
• Use motivational interviewing and coaching to promote member engagement and healthy behavior change
• Educate and empower members to participate in their own healthcare decision-making
• Ensure documentation and compliance with regulatory, accreditation, and company policies

 
Required Qualifications:

• Bachelor’s degree in Social Work or related field (No nursing candidates)
• Bilingual Spanish/English (reading, writing, speaking)
• Case management experience required
• Proficiency in Microsoft Office, including Excel
• Ability to multitask, prioritize, and adapt in a fast-paced environment
• Strong verbal and written communication skills

 
Preferred Qualifications:

• Long-term care experience