*Healthcare Consultant I Miami Dade County, FL
Healthcare
Description
Job Title
Healthcare Consultant 1
Location
Miami Dade County, FL
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.
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 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 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.
• Case management experience required.
• Long term care experience preferred.
• Microsoft Office including Excel competent.
• 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.
• Verifyable High School Diploma or GED Required.
Job Title
Healthcare Consultant 1
Location
Miami Dade County, FL
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.
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 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 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.
• Case management experience required.
• Long term care experience preferred.
• Microsoft Office including Excel competent.
• 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.
• Verifyable High School Diploma or GED Required.