Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

MnNtUkNBV2hjWmRpS3NSc091VVZkMzVoUlE9PQ==
  • 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

Hansons

Regional General Manager, Sales & Operations Job at Hansons

 ...A prominent home improvement company in Troy, MI is looking for a General Manager to oversee branch operations. The ideal candidate will have extensive experience in sales management and general management, driving customer satisfaction and sales performance. Responsibilities... 

SCI Shared Resources, LLC

Funeral Director/Embalmer Job at SCI Shared Resources, LLC

 ...Corporation International (SCI) includes the Dignity Memorial brand and is the North America's largest provider of cremation, funeral and cemetery services. Learn more at SCI-Corp.com Ongoing training Advancement opportunities Competitive bonus plan... 

Greenberg-Larraby, Inc. (GLI)

Urologist Job at Greenberg-Larraby, Inc. (GLI)

 ...to become a key member of our medical team. The ideal candidate will...  ...to fostering a collaborative work environment that values professional...  ...and maintain detailed medical records. Minimum Requirements:...  ...& Development Work From Home Disclaimer:... 

The Skin Clique

Texas: Physician Assistant Job at The Skin Clique

 ...in-person, concierge aesthetics procedures throughout your community. Board Certification as a Nurse Practitioner (NP) or Physician Assistant (PA) Master's Degree from an accredited NP or PA program Current BLS or ACLS certification Auto-Insurance Coverage... 

Showami

Hoboken Real Estate Showing Agent — Earn per Showing + Tips Job at Showami

 ...A real estate service provider is seeking licensed real estate agents in Hoboken, New Jersey, to assist with various tasks including showings and inspections. Agents will earn an average of $34 or more per task, with additional payment opportunities for tips. This role...