Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

M1AzdkdZWlJZZ1hZNE0xYTdDbzhqL2NkdHc9PQ==
  • 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

Pressley Ridge

Special Education Aide (1:1) - Pressley Ridge School for Autism (Pittsburgh, PA) Job at Pressley Ridge

 ...Title: Special Education Aide (1:1) - Pressley Ridge School for Autism (Pittsburgh, PA) Job Category: Education Requisition Number...  ...holiday ~ Tuition reimbursement (if applicable)~ Employee Assistance Program (EAP) Position Summary The Special Education... 

Osmose Utilities Services

Financial Analyst Internship Job at Osmose Utilities Services

 ...primary focus on reducing unbilled revenue, improving unbilled aging visibility, standardizing accrual processes, and minimizing Accounts Receivable (AR) across the Project Management portfolio.This role supports analysis and action at the intersection of Project Management... 

Ashley | The Wellsville Group

Customer Service Representative Job at Ashley | The Wellsville Group

 ...Corporate Customer Service Center in Batavia, NY. In this role, youll be the heart of our customer experience, resolving concerns, managing warranty inquiries, and coordinating solutions across multiple states. With the potential to transition to a work-from-home... 

EVONA

Senior Electrical Engineer Job at EVONA

 ...Senior Electronics Engineer Denver, CO Our exciting Space client in the Denver area are looking for a Senior Electrical Engineer with a strong background across Digital and Mixed-Signal Electronics Design In this role you will work across the full concept development... 

Stealth Startup

Founding Bioinformatics Scientist Job at Stealth Startup

The Opportunity We're building the data layer that every AI drug discovery will run on. Backed by an Nvidia VP. Working with top AI labs, global tech company and global pharma. Growing fast. We need a scientist who can lead not just do the work. Role ...