Healthcare Management Consultant II
2 weeks ago
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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