Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

UTZvMDh4anVOOUN5NVFvd3V3d2R2NTIyOFE9PQ==
  • 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

Full time, Immediate start,

Similar Jobs

Prime Safety Management LLC

Safety Manager Job at Prime Safety Management LLC

 ...Role Description This is a full-time, on-site Safety Manager role at Prime Safety Management LLC in San Diego, CA, supporting a GC on industrial construction projects. The Safety Manager will be responsible for conducting site safety audits over the West Coast... 

SnapDragon Associates, LLC

Cabinet Maker Job at SnapDragon Associates, LLC

 ...projects, reflecting their reputation for exceptional work. The Role The company is seeking a talented and detail-oriented Cabinet Maker to join their dedicated team of professionals. This role focuses on the creation of bespoke millwork and custom cabinetry,... 

Crossover Health

Health And Wellness Coach Job at Crossover Health

 ...About Crossover Health Crossover makes remarkable health possible by bringing people...  ...protocols Serves as a consultant and educational resource to providers and members Performs...  .... Health Education, Nutrition, Nursing, Public Health, Exercise Physiology, Psychology)... 

Tsubaki ATR, LLC

Keyway Broaching / Machinist - ATR Job at Tsubaki ATR, LLC

Description: The TSUBAKI name is synonymous with excellence in quality, dependability and customer service. U.S. Tsubaki is a leading manufacturer and supplier of power transmission and motion control products. As a part of a vast, international network of corporate and...

Tremco CPG Inc.

Roofing Contractor Support Specialist Job at Tremco CPG Inc.

 ...relationship with the existing contractor base, keeping them informed and trained on Tremco s product line and new products introduced. Develop new contractors in the area, per the local sales team, by training on product systems and their usage. Skills, Qualifications,...