Job Title: Medical Management Specialist
Job Purpose: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing, and providing data for regulatory reports. This position will represent the company to members.
Key Responsibilities:
- Conduct medical management and health education programs for customers on government health care programs.
- Gather, analyze, and provide data for regulatory reports.
- Perform assessments, care planning, and care coordination in the member/family home and telephonically.
- Represent the company to members.
Job Qualifications:
- Registered Nurse (RN) with 3 years of direct clinical care to the consumer in a clinical setting, or Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW), which includes 2 years of clinical practice to obtain their LPC or LMSW license.
- Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensees changing permanent residence to the state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
- Plus 3 years of wellness or managed care experience presenting clinical issues with members/physicians.
- Knowledge of the health and wellness marketplace and employer trends.
- Verbal and written communication skills, including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
- Analytical experience, including medical data analysis.
- Current driver's license, transportation, and applicable insurance.
- Ability and willingness to travel within the assigned territory.
- PC proficiency to include Word, Excel, and PowerPoint, database experience, and web-based applications.
Preferred Job Qualifications:
- 3 years of clinical experience.
- Patient education experience.
- Condition management experience.
- Bilingual in English and Spanish.
- Transition of care experience.
- Experience in managing complex or catastrophic cases.
- Certification in Case Management, Training, Project Management, or a nationally recognized health care certification.