Job Description

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, or
Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW) with 2 years of clinical practice to obtain their LPC or LMSW license
Current, valid, unrestricted license in the state of operations (or reciprocity)
Plus 3 years 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
Analytical experience including medical data analysis
Current driver's license, transportation, and applicable insurance
Ability and willingness to travel within assigned territory
PC proficiency to include Word, Excel, and PowerPoint, database experience, and Web-based applications

Nice to Have Skills:

3 years 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 nationally recognized health care certification

Preferred Qualifications:

Experience in managing complex or catastrophic cases
Certification in Case Management, Training, Project Management, or nationally recognized health care certification

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