Healthcare Management Consultant II

2 weeks ago


Topeka, Kansas, United States Conflux Systems Full time
Job Overview

Position Title: Healthcare Consultant II

Company: Conflux Systems

Role Summary: The Healthcare Consultant II will provide essential healthcare management services aimed at optimizing treatment pathways, controlling healthcare expenditures, and enhancing operational efficiency within healthcare programs.

Key Responsibilities:

  • Conduct thorough assessments of referred members' needs and eligibility, utilizing care management tools and data analysis to propose effective case resolutions.
  • Identify high-risk factors and service requirements that may influence member outcomes, facilitating appropriate referrals to clinical case management or crisis intervention as necessary.
  • Coordinate and execute care plan activities while monitoring progress to ensure the enhancement of medical appropriateness and quality of care.
  • Engage in collaborative consultations with case managers, supervisors, and medical directors to address barriers and achieve optimal health outcomes.
  • Escalate quality of care concerns through established channels and employ negotiation skills to secure necessary services for members.
  • Utilize motivational interviewing techniques to foster member engagement and promote sustainable lifestyle changes.
  • Empower members to make informed healthcare decisions and actively participate in their care.
  • Adhere to case management and quality management processes in alignment with regulatory standards and company policies.

Qualifications:

  • Minimum of 1 year of experience in behavioral health, social services, or a related field.
  • Willingness to travel locally to meet members in person.
  • Reliable transportation is required.

Preferred Skills:

  • Proficiency in computer systems and MS Office Suite, particularly Word and Excel.
  • Experience in case management and discharge planning is advantageous.
  • Background in managed care and home and community-based services (HCBS) waiver is preferred.

Educational Requirements:

A Bachelor's degree or a non-licensed Master's level qualification in behavioral health or human services (e.g., psychology, social work, counseling) is required.



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