Job Description

Job Description

Job Description

Hi Team,

Details needed:

Comfortable in traveling approximately 75%.

Last 4 digits of SSN

DOB - month/date

Experience - Social work with Case management

Here are the job details for your review:

Job Title: Healthcare Consultant I

Client Name: CVS Health/Aetna

Job Location: Need Candidates in South Hillsborough County, FL between Riverview and Sun City Center area.

Duration: 5 months (possibility to extension)
Pay Rate: $37.39/HR on W2
Shift Timings : Monday -Friday 8AM-5PM

Job Description:

Need Candidates in South Hillsborough County, FL between Riverview and Sun City Center area.

Location: Candidates must reside in Hillsborough County, FL.
Training will be conducted remotely via Microsoft Teams.
Candidates will travel approximately 75% of the time within the region seeing Members at home, in assisted living facilities and nursing homes. Travel miles will be paid

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.

Roles And 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, 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 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.

Experience:

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

Preferred Qualifications:
Bilingual Spanish/English
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written

Education:

Bachelor's degree required - No nurses. Social work degree or related field.

Job Tags

Similar Jobs