Healthcare Consultant I

Healthcare Case Manager

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues. Determines medical necessity/appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/compliance opportunities. May also include identification of aberrance's and initiation of corrective action Educates/empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level.

Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilita...