Healthcare Consultant-Case Management

2 weeks ago

Miami, Florida, United States SGS Consulting Full time $7,680 - $72,000 per year

JOB DETAILS BELOW:

Job Title:       Healthcare Consultant - (Case Management)

Location:     Must be local to
Mid Miami Area, FL, North Miami, FL, Miami Dade County, FL, Hialeah, FL any of these areas in Miami.

1.Mid Miami Area, FL (Remote + Field Visit)

2.
North Miami, FL (Remote + Field Visit)

3.Miami Dade County, FL (Remote + Field Visit)

4.Hialeah, FL (Remote + Field Visit)

Hours: hrs/Week

Pay Rate:
     
$36/hr. on W2 + Travel Mileage Reimbursement

Shift:
 Mon - Fri (8am - 5pm) EST.

Position:
Training will be conducted remotely via Microsoft Teams for approximately 1-2 weeks.

  • Require 50-75% travel for face-to-face visits with members.
  • Members at home, in assisted living facilities and nursing homes.

Description:

  • 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.

Position Summary:

  • Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
  • Candidates must be located in mid Miami.
  • This role will require 50-75% travel for face-to-face visits with members in Mid Miami area.

Preferred Qualification:

  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
  • Effective communication skills, both verbal and written
  • Managed Care experience
  • Computer proficiency in Microsoft Word, Excel, and Outlook required
  • Case management and discharge planning experience

Experience Required:

  • One year Case management experience A MUST
  • Case Management Certificate (Preferred)
  • Long term care experience (Preferred)
  • Microsoft Office including Excel competent
  • Bilingual - Spanish / English (required)

Required Qualifications:

Bachelor's degree required - No nurses. Social work degree or related field

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