Healthcare Consultant II

4 days ago


Topeka, Kansas, United States Impresiv Health Full time
Job Description:

Job Title: Healthcare Consultant II

Job Summary:

We are seeking a highly skilled Healthcare Consultant II to join our team at Impresiv Health. As a Healthcare Consultant II, you will play a critical role in providing comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs, and improve healthcare program/operational efficiency involving clinical issues.

Key Responsibilities:

  • Evaluation and Case Management: Conduct comprehensive evaluations of referred members' needs/eligibility and recommend approaches to case resolution and/or meeting needs by evaluating members' benefit plans and available internal and external programs/services.
  • Risk Identification and Escalation: 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 needed.
  • Care Plan Coordination and Monitoring: Coordinate and implement assigned care plan activities and monitor care plan progress, ensuring that members receive timely and effective care.
  • Quality of Care Enhancement: Utilize a holistic approach to consult with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives, and present cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Quality of Care Issue Identification and Escalation: Identify and escalate quality of care issues through established channels.
  • Negotiation and Influencing: Utilize negotiation skills to secure appropriate options and services necessary to meet members' benefits and/or healthcare needs, and utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum levels of health.
  • Member Empowerment and Education: Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices, and help members actively and knowledgeably participate with their providers in healthcare decision-making.
  • Care Monitoring, Evaluation, and Documentation: Monitor, evaluate, and document care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements:

  • Experience: Minimum of 2 years of experience in a clinical support role, preferably in a managed care setting.
  • Education: Bachelor's degree or non-licensed master's level clinician required, with either degree being in behavioral health or human services preferred (psychology, rehabilitation, social work, marriage, and family therapy, counseling).
  • Skills: Computer literacy and demonstrated proficiency in navigating internal/external computer systems, and MS Office Suite applications, including Word and Excel, is strongly preferred.
  • Travel: Willing and able to travel up to 50%-75% locally to meet members face-to-face.
  • Reliable Transportation: Must have reliable transportation.


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