Long Term Care - Case Manager

SGS Consulting; Florida; On-site; USD 65,000 - 85,000; Full time

Job summary

SGS Consulting is seeking an experienced healthcare case manager based in South Miami to provide comprehensive healthcare management services. This role involves significant travel for face-to-face visits and requires effective collaboration and management of care plans to achieve optimal health outcomes.

The ideal candidate must possess at least one year of case management experience and a bachelor’s degree in social work or a related field. Key skills include critical thinking, effective communication, and computer proficiency.

Qualifications

• Minimum one year of case management experience required.
• Case Management Certificate preferred.
• Long-term care experience preferred.

Responsibilities

• Facilitates appropriate healthcare outcomes through care coordination.
• Monitors care plan progress and conducts multidisciplinary reviews.
• Secures options and services to meet member healthcare needs.

Skills

Critical thinking

Effective communication

Computer proficiency

Negotiation skills

Motivational interviewing

Education

Bachelor's degree in social work or related field

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

• Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.
• Candidates must be located in South Miami.
• This role will require 50-75% travel for face-to-face visits with members in Miami Dade.
• Schedule is Monday-Friday, 8:00am-5:00pm, standard business hours.

Duties

• 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
• 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 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

• One year Case management experience A MUST / Case Management Certificate (Preferred)
• Long term care experience (Preferred)

Preferred Qualifications

• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written
• Managed Care experience
• Computer proficiency in Microsoft Word, Excel, and Outlook required

Education

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

What days & hours will the person work in this position? List training hours, if different.