Healthcare Consultant I

SGS_JOB_2717

Business Support
 Florida
Case Management
Case Manager
Case Manager
Long Term Care
Prior Authorization

Contract - 03+ Months Extendable

o Location (mandatory): Candidates must reside in Miami Dade County, FL (33172, 33182 in FL 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 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 support due to members’ health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and support.

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 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 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:

  • Case management experience required
  • Long term care experience preferred
  • Microsoft Office including Excel competent

Education/Experience:

  • Bachelor's degree required - No Nurses. Social Work degree or related field.

Related Jobs

IT Contract Specialist

Business Support
Remote
05 months

IT Contracts Specialist supports the, development, negotiation, renewal, maintenance, and compliance of IT contracts with established standard terms, conditions, and templates. Working in close collaboration with the IT Contracts Manager, various business stakeholders, IT leaders, and Legal counsel, this role is responsible for contract execution, assessing contractual performance, ensuring compliance with terms and conditions as well as the support of specific standards, service level agreements, and contract administration. The IT Contract Specialist ensures all IT contracting and procurement activity is consistently executed in accordance with HFHS policy. As the senior member of a specialist group, the IT Contract Specialist provides guidance and support to the Contract Specialists and Junior Contract Specialists on System policies and departmental procedures.

IT contract management
Negotiation
Contract review

Category Merch Specialist

Business Support
Remote
03-04 Months

The Category Merch Specialist is responsible for executing specialized support tasks in a specific merchandising department. These functions are exercised across various systems and require timely input with a high level of accuracy. Will provide support tasks related to executing sales and merchandising strategies.

Category management
merchandising
excel
reports

DEPARTMENT SUPPORT SPECIALIST I

Business Support
 Texas
12 Months

Location : Houston Texas The Department Support Specialist I serves as a Tier Two customer support representative, managing escalated customer service cases related to billing and account issues. This role acts as a liaison between customers, internal teams, and external utilities, working primarily in Salesforce within a hybrid work environment. The position requires strong independence, attention to detail, and effective time management.

Customer Service
Salesforce

Procurement Specialist

Business Support
 Kentucky
06+ Months Extendable

Location : Louisville, KY 40202. The Procurement Packaging Specialist (Temporary) will support the Packaging Procurement team in the execution of sourcing activities, supplier coordination, and project follow-up related to ongoing and new packaging developments across the spirits portfolio. This role is ideal for someone detail-oriented, organized, and comfortable working in a fast-paced, cross-functional environment.

Procurement
Sourcing
Packaging
spirits
portfolio Management
packaging projects
CPG
Supply Chain
Wine
Liquor

Project Manager - Facility Maintenance Transition

Business Support
 Texas
9 Months

Location : Fort Worth TX The Project Manager – Facility Maintenance Transition will lead the full transition of facility maintenance responsibilities to the airport authority, ensuring a smooth transfer of processes, scope, and operational knowledge. This role requires strong leadership, strategic planning, and cross-functional coordination to manage stakeholders, mitigate risks, and ensure continuity of facility operations throughout the transition period.

Project manager
Facility.

Product Coordinator

Business Support
 Texas
12 Months

Location : Fort Worth TX The Product Coordinator will support product operations for travel and hotel-related offerings by managing invoicing, updating content, and coordinating projects across departments. This role requires strong organizational skills, attention to detail, and proficiency with Excel and Microsoft tools. The coordinator will interact with high-level partners to gather information and ensure accuracy across platforms while supporting various cross-functional initiatives.

Marketing
Content.

Content Strategist

Business Support
 Texas
12 Months

Location : Fort Worth TX 76155 The Content Strategist will support Technology Strategy & UX team by planning, creating, and managing content across employee-facing digital tools. This role focuses on developing clear, consistent, user-centered content that aligns with brand voice, enhances product usability, and supports both customer service teams and end users. The position requires strong writing skills, UX collaboration, and content governance expertise within a hybrid work environment.

Content
UX

Environmental Consultant

Business Support
 Washington
12 Months

Location : Richland WA The Environmental Consultant will support environmental compliance, permitting, and regulatory review activities for EN in Richland, WA. The role involves performing NEPA/SEPA research, conducting field assessments, preparing environmental documentation, and collaborating with multidisciplinary teams to ensure adherence to federal, state, and local environmental regulations. This position plays a key role in identifying environmental risks, developing strategies, and supporting project decisions through expert analysis and reporting.

Environmental
Compliance

Financial Analyst Sr

Business Support
 New Jersey
6 Months

Location : Carneys Point New Jersey Seeking a Senior Financial Analyst to support business operations through advanced financial analysis, data interpretation, and reporting. This role requires strong analytical skills, expertise in business processes, and proficiency in financial and operational systems to support strategic decision-making.

Financial
workforce
logo

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


2025. All right reserved.
logologologologo