Healthcare Consultant I - North Miami
Job Responsibilities:
- Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollers.
- Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members using 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 members’ 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 members to make ongoing independent medical and/or healthy lifestyle choices
- Helps members 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. ;
Skills:
- 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) ;
Education/Experience:
- Bachelor's degree required – No nurses.
- Social work degree or related field preferred.
Recommended Jobs
Part Time Technology Support Specialist
Work Opportunity: Part Time Technology Support Specialist
Radiology/CT Technologist-Outpatient - The Sanctuary
Location: The Sanctuary - Outpatient Center -8960 Colonial Center Drive Fort Myers FL 33905 Department: Radiology - Diagnostics Work Type: Full Time Shift: Shift 2/11:30:00 AM to 8:00:00…
Pediatric General Surgeon
The selected candidate will be eligible for a $50k sign-on bonus. Nemours Children's Health, Florida , is seeking a dedicated Pediatric Surgeon to join our dynamic team at Lakeland Regional Heal…
Licensed Massage Therapist
JOIN SQUEEZE Squeeze is a feel-good company designed to revolutionize the massage experience, from our forward-thinking technology to our dedication to team member experience. We are focused on th…
Project Manager
Summary The Project Manager is responsible for managing the scope, tasks, resources, issues, and/or risks for a customized application development/implementation or enhancement project. The Project …
Overnight Room Service Attendant
Company Description We are looking for a Overnight Room Service Attendant to join the re-opening of the famed Delano Miami Beach. Set to open its doors in 2026, Delano Miami Beach will fuse historic…
Managing Director, Partnership Marketing
At NASCAR, you will find a community of passionate individuals who care about our sport and are united in seeing it grow. NASCAR seeks a talented professional to join us in the position of Mana…
Inside Sales Associate — Flexible Scheduling
The Inside Sales Associate is responsible for understanding customer needs and offering appropriate solutions to support account growth. This position follows a defined customer experience methodolog…
Center Manager
The Center Manager is responsible for the day-to-day operations of this retail location. He or she will open and close the center, manage productivity and ensure the center’s team delivers world-class…
Account Manager
The Account Manager is responsible for the business operations of an assigned client contracted service area. This position provides field support including – training, guidance with starting new c…