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Job Requirements of Medical Management Specialist I:
-
Employment Type:
Contractor
-
Location:
Albuquerque, NM (Onsite)
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Medical Management Specialist I
Careers Integrated Resources Inc
Albuquerque, NM (Onsite)
Contractor
Job Title: Medical Management Specialist I
Location: Albuquerque, NM 87109
Duration: 13 Months+ with possible extension
Summary:
Job Purpose:
Job Qualifications:
Required:
Preferred Qualifications:
Location: Albuquerque, NM 87109
Duration: 13 Months+ with possible extension
Summary:
- Gather, analyze, and provide data for regulatory reports.
- Represent the company to members enrolled in government health care programs.
Job Purpose:
- Conduct medical management and health education programs for customers on government health care programs.
- Accountable for gathering, analyzing, and providing data for regulatory reports.
- Serve as a company representative to members.
Job Qualifications:
Required:
- Registered Nurse (RN) with 3 years direct clinical care experience in a clinical setting, OR
- Licensed Professional Counselor (LPC), OR
- Licensed Master Social Worker (LMSW) with 2 years clinical practice to obtain their license.
- Current, valid, unrestricted license in the state of operations (or reciprocity).
- For compact licensees changing permanent residence to the state of operations, must obtain active, unrestricted RN licensure within 90 days of hire.
- Minimum 3 years wellness or managed care experience presenting clinical issues with members and physicians.
- Knowledge of health and wellness marketplace and employer trends.
- Strong verbal and written communication skills to discuss medical needs with members, internal staff, management, vendors, and community resources.
- Analytical experience including medical data analysis.
- Current driver’s license, reliable transportation, and applicable insurance.
- Ability and willingness to travel within assigned territory.
- Proficient in PC applications including Word, Excel, PowerPoint, databases, and web-based applications.
Preferred Qualifications:
- 3 years clinical experience.
- Experience in patient education.
- Condition management experience.
- Bilingual in English and Spanish.
- Transition of care experience.
- Experience managing complex or catastrophic cases.
- Certification in Case Management, Training, Project Management, or nationally recognized health care certification.
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