Job Description

Job Description

Job Description

Here are the job details for your review:

Job Title: Healthcare Consultant II

Client Name: CVS Health/Aetna

Job Location: Field, Topeka, KS, USA, 66603

Duration 5 months (possibility to extension)
Pay Rate: $43.74/HR on W2
Shift Timings: Mon - Fri 8:00 - 5:00 CST

LOCATION NEEDED WILL BE:

Description :

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues.

Roles and Responsibilities:

- 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 in order 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 in compliance with regulatory and accreditation guidelines and company policies and procedures

Experience:

1+ year(s) behavioral health, social services, or human services field.
-Willing and able to travel up to 50%-75% locally to meet members face to face
- Must have reliable transportation.

Preferred Qualifications :
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel is strongly preferred.
- Case management and discharge planning experience preferred
- Managed Care experience preferred
-1-year Experience in Home and Community based services (HCBS) waiver.

Education :

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, rehabilitation, social work, marriage and family therapy, counseling).

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