Medical Management Specialist I

Job Summary:

• 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 date for regulatory reports.
• This position will represent the company to members.

Required Qualifications:

• 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), 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 licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
• 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 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 assigned territory.
• PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.

Experience & 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.
• Behavioral health and physical health experience requested.

Position Type & Location:

• Behavioral Health Waiver Position -
• Chicago (central, south side, or north side); Skokie or Evanston.
• Example zip codes needed: 60640, 60654, 60613, 60612, 60660, 60625, 60618, 60657, 60647, 60608, 60622, 60614, 60610, 60605, 60616, 60607, 60624, 60637, 60615.