Healthcare Consultant I

SGS Consulting; Tallahassee (FL); On-site; USD 42,000 - 64,000; Full time

Job summary

SGS Consulting is seeking a Case Management Coordinator in Tallahassee, FL to proactively address issues and enhance member wellness through integrated care. You will determine appropriate services, coordinate with PCPs and specialists, and review medications as part of care planning.

You will help members participate in decision-making with providers and ensure ongoing monitoring and documentation of care in line with regulatory standards and company policies.

Qualifications

• Bachelor's degree required.
• No nurses.
• Social work degree or related field.

Responsibilities

• Develop proactive actions to address issues to improve wellness outcomes.
• Determine appropriate services and supports, including prior authorizations and coordination with PCP and skilled providers.
• Help members participate actively and knowledgeably with their provider in healthcare decision-making.
• Monitor, evaluate, and document care in compliance with regulatory guidelines and company policies.

Skills

Case management

Long-term care

Excel

Bilingual Spanish/English

Education

Bachelor's degree

Social work degree or related field

No nurses

Tools

Microsoft Office

Excel

Job description

Job Responsibilities

Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Case Management Coordinator will determine appropriate services and support due to members’ health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.Helps members actively and knowledgeably participate with their provider in healthcare decision-makingMonitoring, 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

Case management experience required, long term care experience preferredMicrosoft Office including Excel competenceBilingual Spanish/English Required

Education/Experience

Bachelor's degree requiredNo nursesSocial work degree or related field.