We are seeking a highly skilled and compassionate Medical Management Specialist I to join our team. As a Medical Management Specialist I, you will play a critical role in conducting medical management and health education programs for our customers on government healthcare programs. Your expertise will help us gather, analyze, and provide data for regulatory reports, while also representing our company to members.
Key Responsibilities :
- Conduct medical management and health education programs for customers on government healthcare programs
- Gather, analyze, and provide data for regulatory reports
- Represent the company to members
- Present clinical issues with members and physicians
- Interface with internal staff / management and external vendors and community resources
Requirements :
Registered Nurse (RN) with 3 years direct clinical care to the consumer in a clinical setting, orLicensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW) with 2 years of clinical practice to obtain their LPC or LMSW licenseCurrent, valid, unrestricted license in the state of operations (or reciprocity)Plus 3 years wellness or managed care experience presenting clinical issues with members / physiciansKnowledge of the health and wellness marketplace and employer trendsVerbal and written communication skillsAnalytical experience including medical data analysisCurrent driver's license, transportation, and applicable insuranceAbility and willingness to travel within assigned territoryPC proficiency to include Word, Excel, and PowerPoint, database experience, and Web-based applicationsNice to Have Skills :
3 years clinical experiencePatient education experienceCondition Management experienceBilingual in English and SpanishTransition of Care experienceExperience in managing complex or catastrophic casesCertification in Case Management, Training, Project Management, or nationally recognized health care certificationPreferred Qualifications :
Experience in managing complex or catastrophic casesCertification in Case Management, Training, Project Management, or nationally recognized health care certification