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Healthcare Consultant III

9bjdnw2mlhip8doaz2t0q9w4wphk960418ms6mtfp5oxvgnr76bfafpnr8c62y27 · 30+ days ago

Remote, IL, US

$65k+
Estimation

Full-time

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Healthcare Consultant III

Location: Remote
Duration: 5 months

Description:
The Field Case Management Coordinator utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Experience with case management is preferred.

Evaluation of Members:
Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
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 programs to overcome barriers to meeting goals and objectives presents cases at case conferences to obtain multidisciplinary review in order 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 member to make
ongoing independent medical and/or healthy lifestyle choices.
-Helps member actively and knowledgably 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.

Experience
Case management experience preferred
2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred

Position Summary
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.

Education:
Bachelor's degree in behavioral health or human services REQUIRED (psychology, social work, marriage and family therapy, nursing, counseling, etc.) or non-licensed masters-level clinician.

Qualification
Must Have
Client Requirements
Prior Client work experience
•

Last updated on Nov 14, 2023

About the company

9bjdnw2mlhip8doaz2t0q9w4wphk960418ms6mtfp5oxvgnr76bfafpnr8c62y27

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