Healthcare Consultant IOur Client, a Retail Pharmacy company, is looking for a Healthcare Consultant I for their Columbus, OH/Remote location.Responsibilities: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:Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.Determines medical necessity/ appropriatenessFacilitates optimal outcomesIdentifies and follow through with continuous quality/ compliance opportunities. May also include identification of aberrance's and initiation of corrective actionEducates/ empowers customers to ensure compliance, satisfaction and promote patient advocacyOptimize total costsImplementation and evaluation of policy based on usage and program directivesEducate/empower colleagues at all levels to enable decision making at most appropriate levelRequirements:Minimum 1 year of relevant experienceBachelor's degree or non-licensed master level clinician requiredVerifyable High School Diploma or GED RequiredWhy Should You Apply?Health BenefitsReferral ProgramExcellent growth and advancement opportunities
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