Healthcare Consultant I (Seminole County, FL)

Duration: 03 Months.

Seeking a self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday-Friday working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Skills: Must Have:

• Minimum 1 year of relevant experience in case management.
• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.

Experience: REQUIRED QUALIFICATIONS:

• Determines medical necessity/ appropriateness.
• Facilitates optimal outcomes.
• Identifies and follow through with continuous quality/ compliance opportunities. May also include identification of aberrances and initiation of corrective action.
• Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy.
• Optimize total costs.
• Implementation and evaluation of policy based on usage and program directives.
• Educate/empower colleagues at all levels to enable decision making at the most appropriate level.

Professional Qualification:     

• High School Diploma.

Experience Required: 01 – 02 Years.

Shift: Mon-Fri 8-5