Healthcare Consultant I North Miami area

Title: Healthcare Consultant I - North Miami area
Location: (North Miami Aventura Hialeah or Miramar)
Shift: Mon-Fri 8am to 5pm
Duration: 3 Months (Possibility of extension)
Pay rate: $34.11/hr

Location: Work from Home. Candidates must reside in North Miami Aventura Hialeah or Miramar.
Training will be conducted remotely via Microsoft Teams.
Candidate will travel approximately 75% of the time within the region seeing members at home in assisted living facilities and nursing homes

Bilingual (English / Spanish) REQUIRED - must be Fluent speaking and writing.
Mileage reimbursement is approved to and from member homes.
Candidates must be located in North Miami Dade county
This role will require 50-75% travel for face-to-face visits with members in Miami Dade.
Schedule is Monday-Friday 8:00am-5:00pm standard business hours.

• We are seeking self-motivated energetic detail oriented highly organized tech-savvy Case Management Coordinator to join our Case Management team.
• This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday -Friday working schedule paid holidays 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 members 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 members overall wellness through integration.
• Case Management Coordinators will determine appropriate services and supports 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 supports.

Position Summary

• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment effectively manage healthcare costs and improve healthcare program and operational efficiency involving clinical issues.

Key Duties & Responsibilities

• Determine medical necessity and appropriateness of healthcare services
• Facilitate optimal patient outcomes through effective care coordination
• Identify monitor and follow through on continuous quality and compliance opportunities
• Recognize aberrances and initiate corrective actions as needed
• Educate and empower customers to ensure compliance satisfaction and promote patient advocacy
• Optimize total healthcare costs while maintaining quality standards
• Implement and evaluate policies based on utilization and program directives
• Educate and empower colleagues at all levels to support informed decision-making at the most appropriate level

Required Experience & Skills

• Case management experience required
• Long-term care experience preferred
• Proficiency in Microsoft Office applications including Excel

Education Requirements

• Bachelors degree required
• Degree in nursing social work or related clinical field not required