Healthcare Consultant I Job at ICONMA, Columbus, OH

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  • ICONMA
  • Columbus, OH

Job Description

Our 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/ 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

Requirements:
  • Minimum 1 year of relevant experience
  • Bachelor's degree or non-licensed master level clinician required
  • Verifyable High School Diploma or GED Required

Why Should You Apply?
  • Health Benefits
  • Referral Program
  • Excellent growth and advancement opportunities

Job Tags

Immediate start

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