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*Healthcare Consultant I

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*Healthcare Consultant I

  • Location:

    Vinton

  • Sector:

    MRS Nursing

  • Job type:

    Temporary & Contract

  • Salary:

    Negotiable

  • Contact:

    James Bernas

  • Contact email:

    jbernas@medicalrecruitmentstrategies.com

  • Job ref:

    BBBH410266_1671575098

  • Published:

    about 1 month ago

  • Duration:

    3 months

  • Expiry date:

    2023-03-20

  • Startdate:

    1/23/2023

  • Client:

    Medical Recruitment Strategies

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: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain 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 knowledgably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes incompliance with regulatory and accreditation guidelines and company policies and procedures