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Healthcare Consultant

2 months ago

Topeka, Kansas, United States Umanist Staffing LLC Full time
Job Description

**Job Summary:**

This is a full-time telework role in a remote setting, requiring 50-75% travel for face-to-face visits in the assigned area once COVID restrictions are lifted. The schedule is Monday-Friday, standard business hours.

**Key Responsibilities:**

  • Evaluation of Members:
  • Conduct comprehensive evaluation of referred member's needs/eligibility using care management tools and information/data review.
  • Recommend an approach to case resolution and/or meeting needs by evaluating the member's benefit plan and available internal and external programs/services.
  • Identify high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
  • Enhancement of Medical Appropriateness and Quality of Care:
  • Consult with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives using a holistic approach.
  • Present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
  • Identify and escalate quality of care issues through established channels.
  • Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an optimum level of health.
  • Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Help members actively and knowledgably participate with their provider in healthcare decision-making.
  • Monitoring, Evaluation, and Documentation of Care:
  • Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

**Requirements:**

  • 1 year(s) in behavioral health, social services, or human services field.
  • Willing and able to travel up to 50%-75% locally to meet members face to face.
  • Must have reliable transportation.

**Preferred Qualifications:**

  • Computer literacy and demonstrated proficiency in navigating through internal/external computer systems.
  • Proficiency in MS Office Suite applications, including Word and Excel, is strongly preferred.
  • Case management and discharge planning experience preferred.
  • Managed Care experience preferred.
  • 1-year experience in Home and Community-Based Services (HCBS) waiver.

**Education:**

  • Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, rehabilitation, social work, marriage and family therapy, counseling).