Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

TkxhbFFCd29SSWVwZGFXTVN6aE5KTmRIcVE9PQ==
  • 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

Fleis & VandenBrink

Water Operations Specialist Job at Fleis & VandenBrink

 ...Brief Description F&V Operations and Resource Management (FVOP) is a highly successful, employee-owned and growth-oriented company that assists municipal clients providing water and wastewater treatment plant operation services. Working with the owner, we provide expert... 

Muskingum University

Assistant Professor of Exercise Science Job at Muskingum University

Assistant Professor of Exercise ScienceThe Department of Exercise and Health Science at Muskingum University invites applications for a full-time faculty position in exercise science at the rank of Assistant Professor, beginning in the Fall semester of 2026. The successful... 

HEYTEA

Bakery R&D Specialist Job at HEYTEA

 ...HEYTEA is a pioneering and trend-setting new-style tea drink brand born in 2012. We are obsessed with creating inspired drinks and bakery items that surprise and delight our customers worldwide. Through continuous innovation with premium ingredients, we redefine the tea... 

Assured Nursing

Travel Rehabilitation LPN Job at Assured Nursing

 ...Job Description Assured Nursing is seeking a LPN / LVN for a travel job in Utica, New York. Job Description & Requirements...  ...Travel Assured Nursing is currently seeking a LPN for a contract position in Utica New York . This is a 11p-7a, 23:00:00-07:00:... 

Polk County Public Schools

Building Code Inspector Job at Polk County Public Schools

 ...Must possess a State of Florida, Department of Business and Professional Regulation standard license as a Building Inspector with the appropriate discipline endorsement. Position Title: ~ Building Code Inspector. FLSA Status: ~ Non-Exempt. Salary Grade...