Healthcare Consultant I

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator 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. 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. Must reside in Miami dade county



Position 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



Experience:



Case management experience required

Long term care experience preferred

Microsoft Office including Excel competent



Education:



Bachelors degree required, no nurses, social work degree or related field