*Healthcare Consultant I - FLA - 33141, 33139
Healthcare
Description
Job Title
Healthcare Consultant 1
Location
Miami Beach
Position Description
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues. Candidates must be located in 33141, 33139. This role requires 50-75% travel for face to face visits with members. Schedule is Monday-Friday 08:00 AM to 05:00 PM, standard business hours.
Roles Responsibilities
• 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 case management tools and resources.
• Conducts comprehensive evaluation of members using case 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 and company policies and procedures.
Skills
• FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written
• Self-motivated, energetic, detail-oriented, highly organized, tech-savvy
• Prior CVS/Aetna work experience (No)
• Minimum 1 year of relevant case management experience
• Case management certificate (Preferred)
• Long term care experience (Preferred)
• Managed Care Experience
• Computer proficiency in Microsoft Word, Excel, and Outlook required
• Case management and discharge planning experience
Education
• Bachelor's degree required - No nurses
• Social work degree or related field
Job Title
Healthcare Consultant 1
Location
Miami Beach
Position Description
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues. Candidates must be located in 33141, 33139. This role requires 50-75% travel for face to face visits with members. Schedule is Monday-Friday 08:00 AM to 05:00 PM, standard business hours.
Roles Responsibilities
• 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 case management tools and resources.
• Conducts comprehensive evaluation of members using case 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 and company policies and procedures.
Skills
• FLUENT Bilingual Spanish/English REQUIRED (both reading and speaking and writing)
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written
• Self-motivated, energetic, detail-oriented, highly organized, tech-savvy
• Prior CVS/Aetna work experience (No)
• Minimum 1 year of relevant case management experience
• Case management certificate (Preferred)
• Long term care experience (Preferred)
• Managed Care Experience
• Computer proficiency in Microsoft Word, Excel, and Outlook required
• Case management and discharge planning experience
Education
• Bachelor's degree required - No nurses
• Social work degree or related field