Job Description

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 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.

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

• Bachelor's degree required
• Degree in nursing, social work, or related clinical field not required

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