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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