Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

K1BJQ2MxY3NlU3l6L2ZwdC8xZS93dW8yREE9PQ==
  • 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

Burger King

Restaurant Shift Leader Job at Burger King

 ...Restaurant Shift Leader Reports to: Restaurant General Manager The Shift Leader oversees all Restaurant activities during their...  ...to brand standards for service, food quality, and safety. Creates...  ...experience. Previous fast food restaurant experience required... 

Officeworks Inc.

Interior Designer Intern Job at Officeworks Inc.

 ...We are currently seeking an Interior Design intern to join our team in Charlotte, NC. The intern can expect to work up to 32 hours a...  ...Education and Experience: ~ Bachelors Degree in Interior Design, Industrial Design, Architecture, or similar or equivalent experience ~1+... 

JANUS et Cie

Product Design Intern Job at JANUS et Cie

Product Development & Design Summer Internship JANUS et Cie | Santa Fe Springs, CA Are you passionate about design, product innovation, and bringing ideas to life? At JANUS et Cie, weve spent more than 40 years shaping the world of design-driven furnishings. Our...

Denali Water Solutions LLC

Class A CDL Shuttle / Route Driver: Req # 3847 Job at Denali Water Solutions LLC

 ...organic material, and nearly every person who purchases and consumes food in the U.S. Apply to join our team today! Class A CDL Shuttle / Route Driver Akron, OH & Cleveland, OH Full-Time | Hourly - Shift starts at (5 am) About the Role The Class A CDL... 

Hedy Holmes Staffing Services

Sanitation Technician Job at Hedy Holmes Staffing Services

 ...Position: Sanitation Technician Pay Rate: $17.60 /hourly Location: Lodi, CA Schedule: Monday Friday | 6:00 AM 3:00 PM Job Description We are seeking a reliable and detail-oriented Sanitation Technician to maintain high standards of cleanliness...