Medical Management Specialist

Job Title: Medical Management Specialist
Location: Remote
Duration: 06 months (Possibility of extension)
 
Shift timings: Standard hours - 8:00 AM to 5:00 PM (Mon-Fri)
 
Job Summary:

• This position is telephonic only for our Travis County STAR/CHIP LOB.
• This is a Special Beginnings role so experience with L&D, Postpartum care, and newborn/NICU is important.
• This role provides care during the pregnancy and postpartum period for case management
• NICU experience is not required
• This position is responsible for conducting medical management and health education programs for customers on government health care programs.
• This role will include gathering, analyzing and providing date for regulatory reports.
• This position will represent the company to members.

• Responsible for conducting medical management and health education programs for customers on government health care programs.
• Other responsibilities include gathering, analyzing, and providing data for regulatory reports.
• This position will represent the company to members.

• 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.

• 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.