Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

UDRFRnlocEdXdEY1RDloNy91TGh5ZTUyZ3c9PQ==
  • SGS Consulting
  • Remote

Job Description

Job Responsibilities:

  • Coordinates and implements assigned care plan activities and monitors care plan progress.
  • Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Works collaboratively with the members' Child and Family Teams.
  • 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. Help members actively and knowledgably participate with their provider in healthcare decision-making. Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
  • 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:

  • The Care Management Associate (CMA) role is a full-time remote telework position. Qualified candidates must reside in Ohio. Candidates must have a private location to complete all work that is free from distractions or other individuals. You will need to secure your own internet but, your equipment will be provided to you prior to your first day.
  • Recent experience working for other MCOs, specifically within the last 5-7 years in the state of Ohio. Experience may be replaced with recent employment with healthcare organizations or companies. Must be able to pass the CANS assessment and obtain certification within 90 days of employment.

Education/Experience:

  • HS Diploma, GED or Equivalent Experience

Job Tags

Remote job, Full time, Immediate start

Similar Jobs

Pi-Square Technologies LLC

Industrial Engineer Job at Pi-Square Technologies LLC

 ...Industrial Engineer Job Summary An Industrial Engineer is responsible for optimizing processes, improving productivity, reducing costs, and ensuring efficient utilization of resources in manufacturing or service environments. The role focuses on analyzing workflows... 

Mozilla

Remote Marketing Specialist Job at Mozilla

 ...Corporation and has its own compensation programs, benefits, and employment policies. To learn more, visit The opportunity The Marketing Specialist at MZLA executes digital marketing activities that support Thunderbirds brand awareness, user growth, and product... 

Vox Media

Manager, Podcast Partner Operations Job at Vox Media

Create a Job AlertInterested in building your career at Vox Media, LLC? Get future opportunities sent straight to your email.

Walt Disney World Resort

Entertainment Stage Technician- Full Time/Part Time, Walt Disney World Job at Walt Disney World Resort

 ...will have the experience of watching Guests react as they are transported by live shows, parades, and spectaculars across the Walt Disney World Resort. As an Entertainment Stage Technician, you will install, operate, and maintain the lighting, audio, props, video, pyrotechnics... 

Encore Enterprises, Inc.

Hotel Sales Manager Job at Encore Enterprises, Inc.

 ...Q&C Hotel/Bar, an Autograph Collection by Marriott, is seeking a Hotel Sales Manager . Marriott experience is preferred, as well as knowledge of the local corporate market. As a Hotel Sales Manager , you will lead all daily sales-related functions with a focus on...