Job Summary:
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level
Responsibilities:
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
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.
Experience:
Case management experience required
Long term care experience preferred
Microsoft Office including Excel competent
Education:
Location: Work from Home. Candidates must reside in Miami-Dade County, FL.
Training will be conducted remotely via Microsoft Teams for approximately 1-2 weeks.
Candidate will travel approximately 75% of the time within the region seeing
Members at home, in assisted living facilities and nursing homes.
Preferred Qualifications:
Bilingual Spanish/English
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Effective communication skills, both verbal and written
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ( .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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