Healthcare Consultant I - Ohio

SGS_JOB_1985

Business Support
Remote
Administrative
Excel

Contract - 06+ Months

Location: REMOTE in OH State Work Schedule: Schedule is Monday – Friday, 8am-5pm, standard business hours. No required holidays or weekends This role serves as the "Front desk" to the plan. This individual will work on a variety of administrative tasks to assist the Care Coordination department that may include but are not limited to, the inbound care management queue line, responding to questions and inquiries from both members/guardians or parties assisting with services. They will be responsible for taking referrals, confirming their Medicaid eligibility and processing the referral. This role will also complete Health Risk Assessments for all members assigned. It is imperative that the CMA must be able to practice both a high level of professionalism and compassion at all times when interacting with various departments or member representatives. The CMA will also support administrative needs that involve comfortability with working in complex data systems, an Electronic Record System and/or Excel at any given time. Tasks can change with little notice to meet the demands of the health plan requiring flexibility.

Job Responsibilities:

  • Coordinates and implements assigned care plan activities and monitors care plan progress.
  • Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Works collaboratively with the members' Child and Family Teams.
  • 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. Help members actively and knowledgably participate with their provider in healthcare decision-making. Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
  • 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:

  • The Care Management Associate (CMA) role is a full-time remote telework position. Qualified candidates must reside in Ohio. Candidates must have a private location to complete all work that is free from distractions or other individuals. You will need to secure your own internet but, your equipment will be provided to you prior to your first day.
  • Recent experience working for other MCOs, specifically within the last 5-7 years in the state of Ohio. Experience may be replaced with recent employment with healthcare organizations or companies. Must be able to pass the CANS assessment and obtain certification within 90 days of employment.

Education/Experience:

  • HS Diploma, GED or Equivalent Experience

Related Jobs

Principal Project Manager

Business Support
 Texas
10 Months

Location : Fort Worth Texas We are seeking an experienced Principal Project Manager to lead CAPEX and tech transfer projects in a cGMP manufacturing environment at the Vacaville site. This role requires managing complex, cross-functional initiatives from planning through execution, ensuring projects are delivered on time, within budget, and in compliance with regulatory and quality standards.

Project
Capex

Shipping/Receiving Specialist

Business Support
 Connecticut
03+ Months Extendable

Location : New Haven, CT 06511 Shift: MON - FRI 7:30am to 4pm The candidate will be working in a fast-paced shipping/receiving department and working on a loading dock in a hospital. The job description entails processing in-coming and outgoing shipments for the hospital, delivering packages to end-users within the hospital and processing shipment paperwork through an electronic receiving system. There is lots of walking and standing on your feet for long periods

Customer Service
Mailroom
Shipping
Receiving

Mailroom Specialist

Business Support
 Massachusetts
03+ Months Extendable

Location : Marlborough, MA 01752 Shift: MON - FRI 8am to 5pm Looking for someone that is Customer-Service oriented

Customer Service
Mailroom
Shipping
Receiving

Clinical Operations Analyst

Business Support
Remote
06+ Months Extendable

The Analyst will develop test plans, test cases and test scripts for projects, among other assigned duties. The Analyst will perform testing on various software and reporting systems. The Analyst will work closely with PA Admin and Medicare Operations to test and validate the utilization management (UM) criteria, decision trees, drug lists, and letters that are loaded and functioning properly in the PA (MHK) system. Also, the analyst will be responsible for configuration quality control, code testing and test case writing. Additional responsibilities: include ensuring the quality of PA Admin products for internal/external business users by testing cases and doing regression testing.  As an Analyst developing and executing formal test plans to ensure the delivery of quality software and to ensure that all information systems products and services meet minimum organization standards and end-user requirements. 

Software Testing
test plans
test CASE
Medicare

Medical Grants and Sponsorship Manager

Business Support
 Massachusetts
06 Months + (Contract to Hire)

Location: Cambridge, MA 02139 (Hybrid) The Medical Grants and Sponsorship Manager provide operational support for the review, coordination, and administration of educational grants and sponsorship programs. This role helps manage grant submissions, coordinate communications with applicants and internal stakeholders, track agreements and payments, and support reporting and operational analysis. The Manager will also assist in developing medical education and external sponsorship strategies and goals in close collaboration with the Therapeutic Area (TA) medical strategy team, including Medical Directors, the External Engagement Lead, and Ethics & Compliance. The ideal candidate will have experience in the pharmaceutical industry with a background in grants and sponsorships, as well as strong organizational, communication, and analytical skills.

analytical
SOPs
Ethics & Compliance

Probabilistic Safety Analysis Engineer III- New Nuclear

Business Support
 Washington
12 Months

Location : Richland, WA, 99354 A Probabilistic Safety Analysis (PSA) Engineer works on evaluating and improving the safety of nuclear power systems using risk-based methods. The role involves analyzing potential hazards, supporting reactor design and construction, ensuring compliance with regulatory standards, and contributing to the safe operation of advanced nuclear technologies

Probabilistic
Nuclear
Safety

Probabilistic Safety Analysis Engineer I- New Nuclear

Business Support
 Washington
12 Months

Location : Richland, WA, 99354 A Probabilistic Safety Analysis (PSA) Engineer works on evaluating and improving the safety of nuclear power systems using risk-based methods. The role involves analyzing potential hazards, supporting reactor design and construction, ensuring compliance with regulatory standards, and contributing to the safe operation of advanced nuclear technologies

Probabilistic
Nuclear
Safety

TECHNICAL WRITER II

Business Support
 Illinois
9 Months

Location : WARRENVILLE Illinois 60555 We are seeking a meticulous and detail-oriented Technical Writer to join our team. In this role, you will be responsible for developing, writing, and editing comprehensive supply policies and procedures. You will work closely with various departments within and outside of Supply to ensure all documentation is accurate, clear, and accessible, supporting the efficient operation of our supply chain processes

Technical
Writing
Supply

Training Specialist Sr

Business Support
 Pennsylvania
12 Months

A Senior Training Specialist designs and develops effective learning programs and training materials for employees. The role focuses on creating engaging eLearning and instructor-led content using structured instructional design methodologies to enhance workforce skills and performance

ADDIE
Articulate
logo

At SGS Consulting, we go beyond resume-job matches, creating meaningful connections and pathways for individuals to thrive in defining careers.


© 2026 All rights reserved.
logologologologo