Healthcare Consultant I - Melbourne or Palm Bay, FL area

Healthcare Consultant I - Melbourne or Palm Bay, FL area SGS_JOB_3030 Business Support Florida Healthcare Consultant case Management Prior Authorization Medicaid Long Term Care Bilingual Spanish Contract - 06+ Months Extendable Location : Work from Home. Candidates must reside in Brevard County, FL. (Melbourne/Palm Bay) Shift: Mon - Fri (8am to 5pm) EST Dress Code: Business Casual We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Bilingual in Spanish Case Management Coordinator to join our Case Management team. Specifically, Brevard County (Melbourne/Palm Bay) 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 complex members. Develop 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 enrollees. 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 Help 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: Bilingual Spanish/English (not required but preferred) 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. Apply tot his job Apply To this Job