Healthcare Consultant I - Ohio Job at SGS Consulting, Remote

dEhULzdhWlVlNU5tVHVQYVdFalQ1eEg3cWc9PQ==
  • SGS Consulting
  • Remote

Job Description

Job Responsibilities:

  • 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/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review 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. Help members 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.

Skills:

  • The Care Management Associate (CMA) role is a full-time remote telework position. Qualified candidates must reside in Ohio. Candidates must have a private location to complete all work that is free from distractions or other individuals. You will need to secure your own internet but, your equipment will be provided to you prior to your first day.
  • Recent experience working for other MCOs, specifically within the last 5-7 years in the state of Ohio. Experience may be replaced with recent employment with healthcare organizations or companies. Must be able to pass the CANS assessment and obtain certification within 90 days of employment.

Education/Experience:

  • HS Diploma, GED or Equivalent Experience

Job Tags

Full time, Immediate start

Similar Jobs

Shanghai Fanhao Information Technology Co., Ltd.

Government affairs specialist(full time/part time) Job at Shanghai Fanhao Information Technology Co., Ltd.

University degree or equivalent in relevant majors including international relations/politics, public relations, etc. 2+ years of solid...  ...with key government stakeholders at the central and regional levels and government-affiliated think tanks/organizations. Support... 

Atlantic Heating & Cooling Service

Class B CDL Driver Job at Atlantic Heating & Cooling Service

 ...are a high paced company seeking a dependable and efficient CDL driver who possesses a great deal of physical and mental stamina able to...  ...are offering a relocation package to qualified candidates! CDL Truck Driver Job Duties and Responsibilities: Fully understand how... 

Red Bull

2026 Internship, Summer - Youth Programs Marketing Job at Red Bull

 ...s Academy is ranked among the top development organizations in the country. Purpose of this Internship The Summer 2026 Marketing Internship offers hands-on experience in brand strategy, content creation, and campaign execution that powers marketing and growth within... 

Sightline Media Group

Freelance Editor Job at Sightline Media Group

 ...eyes on print pages prior to submission to the printer. Requirements: Proven editorial experience with print publications (newspapers or magazines preferred). Proficiency in Adobe InCopy (required). Excellent copy editing, line editing, and proofreading skills... 

Amazing Athletes

Amazing Athletes JumpBunch - Preschool Multi-Sport and Fitness Coach Job at Amazing Athletes

Are you passionate about sports and helping toddlers and preschoolers stay active? Join our team at Amazing Athletes JumpBunch of Southern CT as a multi-sport coach for toddlers and preschoolers. As a JumpBunch coach, you will travel to different daycares and preschools...