*Healthcare Consultant I - MID MIAMI AREA
Healthcare
Description
Job Title
Healthcare Consultant 1 MID MIAMI AREA
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, 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 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
• One year Case management experience A MUST
• Computer proficiency in Microsoft Word, Excel, and Outlook required
• Managed Care experience
• Case management and discharge planning experience
• Long term care experience (Preferred)
• Microsoft Office including Excel competent
• Prior CVS/Aetna work experience? No
• Verifyable High School Diploma or GED Required
• Case Management Certificate (Preferred)
Education
• Bachelor's degree required - No nurses. Social work degree or related field preferred.
Job Title
Healthcare Consultant 1 MID MIAMI AREA
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, 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 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
• One year Case management experience A MUST
• Computer proficiency in Microsoft Word, Excel, and Outlook required
• Managed Care experience
• Case management and discharge planning experience
• Long term care experience (Preferred)
• Microsoft Office including Excel competent
• Prior CVS/Aetna work experience? No
• Verifyable High School Diploma or GED Required
• Case Management Certificate (Preferred)
Education
• Bachelor's degree required - No nurses. Social work degree or related field preferred.