Healthcare Consultant

Reference Number: KBFLHC72

Healthcare Consultant

Not Disclosed

100% Remote (Within US)

3.0 Months

Not Disclosed

Not Disclosed

Pharmaceutical

$29.11/hour - $34.11/hour

Job Description

Position Summary:
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

We are seeking 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 (8:00AM - 5:00PM) 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.

Required Qualifications
Bi-lingual, English, and Spanish.
1 + year of experience in behavioral health or a long-term care setting

Preferred Qualifications
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Managed Care experience
Computer proficiency in Microsoft Word, Excel, and Outlook required
Case management and discharge planning experience

Education
Bachelor's degree in social work or related field required

Duties
Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
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.
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 member to make ongoing independent medical and/or healthy lifestyle choices
Helps member 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.

Experience
Case management experience required
Long term care experience preferred
Microsoft Office experience required

Qualifications:
FLUENT in Spanish/English (REQUIRED)
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

Notes:
Fully remote (never coming onsite)
Monday through Friday 8AM-5PM
Location: Work from Home.
Training will be conducted remotely via Microsoft Teams for approximately 1-2 weeks.
Candidate will travel approximately 50-75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.