Case Manager

1 day ago

Job Description

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
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.

Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Conducts comprehensive evaluation of Members using care management tools and information/data review
Coordinates and implements assigned care plan activities and monitors care plan progress
Conducts multidisciplinary review to achieve optimal outcomes
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
Helps member actively and knowledgeably participate with their provider in healthcare decision-making, 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.

One year Case management experience A MUST / Case Management Certificate (Preferred)
** Long term care experience (Preferred)
***Microsoft Office including Excel competent
** Bilingual - Spanish / English (required)

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