Job Description

Job Title: Healthcare Consultant I
Job Location: Ohio(Remote)
Job Duration: 3 months+ Extension(09/08/2025 to 12/31/2025)
Mon-Fri 8:00-5:00 EST

Position Summary:

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

Experience: Minimum 1 year of relevant experience

Education: High School Diploma/GED

Duties:

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
Important Skills: Must be proficient with MS Office - with excel, should be comfortable using filters to sort through spreadsheet data.
Outbound call experience is a major plus as these hires will be primarily on outbound calls with members.
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.

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