Healthcare Consultant I - SW Ohio

SGS Consulting; Columbus (OH); Remote; USD 52,000 - 65,000; Full time

Job summary

SGS Consulting is seeking a Case Management Coordinator for a full-time, field-based telework role in Ohio. The position requires travel within Western Ohio to member homes and locations up to 50% or more, with residency in the west region of Ohio.

Typical hours are Monday–Friday, 8–5, with flexibility for additional time to meet member needs. The role supports OhioRISE: coordinating care, educating members, and collaborating with MCOs, vendors, and ODM to improve outcomes for children with

Qualifications

• Bachelor’s degree or non-licensed master level clinician in behavioral health, human services, health services, or public health.
• Experience in Medicaid is preferred.
• Focus on behavioral health and child-serving systems is desirable.

Responsibilities

• Be clinically and culturally competent with training to manage complex cases in the community.
• Evaluation of referred members’ needs and eligibility, and recommendations for case resolution.
• Coordinates and implements assigned care plan activities and monitors progress.
• Enhancement of medical appropriateness and quality of care through collaboration with care teams to overcome barriers.
• Works with the members’ Child and Family Teams and escalates quality of care issues when needed.
• Uses negotiation and motivational interviewing to secure appropriate options and promote engagement.
• Provides coaching and support to empower members to participate in care decisions and healthy lifestyle choices.
• Acts as a single point of contact to remediate gaps in care and access.
• Monitors, evaluates, and documents care per regulatory guidelines.

Skills

Case management

Discharge planning

Managed Care

Medicaid experience

Education

Bachelor’s degree in Behavioral Health

Job description

Job Responsibilities

This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Western Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants must reside within the west region of Ohio. Monday-Friday 8-5pm with flexibility needed to work later to meet member needs. Business Overview As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. The Case Management Coordinator 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. Must reside in Ohio.Applicants must reside within the west region of Ohio.Monday-Friday 8-5pm with flexibility needed to work later to meet member needs.Business OverviewAs part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.The Case Management Coordinator 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. Must reside in Ohio.Applicants must reside within the west region of Ohio.Monday-Friday 8-5pm with flexibility needed to work later to meet member needs.Fundamental Components: Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. Evaluation of Members:Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. Evaluation of Members:Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.Evaluation of Members:Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care:Enhancement of Medical Appropriateness and Quality of Care: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 in order 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.Helps member 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:Monitoring, Evaluation and Documentation of Care: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

Case management and discharge planning experience.Managed Care experience.Medicaid experience.

Education/Experience

Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred. (i.e. psychology, social work, marriage and family therapy, counseling, juvenile justice).