Healthcare Case Manager

US Tech Solutions; Miami (FL); Remote; USD 50,000 - 80,000; Full time

Job summary

Join a forward-thinking company dedicated to providing comprehensive healthcare management services. This exciting role involves coordinating case management activities, optimizing healthcare outcomes, and ensuring compliance with regulatory guidelines. You will work closely with members to facilitate their healthcare decisions and improve overall program efficiency. With a focus on quality improvement and patient advocacy, you will play a vital role in enhancing healthcare delivery. If you are passionate about making a difference in the lives of others and thrive in a collaborative environment, this opportunity is perfect for you.

Qualifications

• Experience in case management and long-term care is essential.
• Must be able to multitask and adapt in a fast-paced environment.

Responsibilities

• Coordinate case management activities for Medicaid enrollees.
• Conduct comprehensive evaluations and monitor care plan progress.

Skills

Case Management

Critical Thinking

Bilingual (Spanish and English)

Verbal Communication

Written Communication

Education

Bachelor's Degree in Nursing or related field

Tools

Microsoft Office

Microsoft Teams

Job description

Job Summary:

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

• Determine medical necessity and appropriateness, facilitate optimal outcomes, and identify opportunities for continuous quality and compliance improvement. This may include identifying aberrances and initiating corrective actions. Educate and empower customers to ensure compliance, satisfaction, and promote patient advocacy. Optimize total costs through implementation and evaluation of policies based on usage and program directives. Educate and empower colleagues at all levels to enable decision-making at the most appropriate level.

Responsibilities:

• Coordinate case management activities for Medicaid Long Term Care/Comprehensive Program enrollees.
• Utilize critical thinking and judgment to collaborate and inform the case management process, facilitating appropriate healthcare outcomes through care coordination, support, and education using care management tools and resources.

• Conduct comprehensive evaluations of members using care management tools and data review.
• Coordinate and implement assigned care plan activities and monitor progress.
• Conduct multidisciplinary reviews to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Help members actively and knowledgeably participate with their providers in healthcare decision-making.
• Monitor, evaluate, and document care in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.

Experience:

• Case management experience required.
• Long-term care experience preferred.
• Proficiency in Microsoft Office, including Excel.

Education and Additional Details:

• 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.
• Approximately 75% travel within the region to see members at home, in assisted living facilities, and nursing homes.

Preferred Qualifications:

• Bilingual in Spanish and English.
• Ability to multitask, prioritize, and adapt effectively in a fast-paced environment.
• Strong verbal and written communication skills.

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 learn more, visit www.ustechsolutions.com.

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.