Medical Management Specialist I

Job Title: Medical Management Specialist I
Location: Must reside in one of the IL 62263 counties: Alexander, Union, Jackson, Pulaski
Duration: 6 Months+

Pay range: $55 - $57/hr. on W2
Schedule: Candidate will be required to complete field work
 
Job Summary:
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 data for regulatory reports. This position will represent the company to members.
 
Job Purpose:

• Conduct medical management and health education programs for customers on government health care programs.
• Responsibilities include gathering, analyzing, and providing data for regulatory reports.
• Serve as a representative of the company to members.

 
Required Qualifications:

• Licensure:
  • Registered Nurse (RN) with 3 years of direct clinical care experience or
  • Licensed Professional Counselor (LPC) or
  • Licensed Master Social Worker (LMSW) with 2 years of clinical practice to obtain license.
  • Current, valid, unrestricted license in the state of operations (or reciprocity).
  • For compact license holders changing residence to state of operations, must obtain active license within 90 days of hire.
• Experience:
  • Minimum 3 years of wellness or managed care experience involving presenting clinical issues to members or physicians.
• Knowledge & Skills:
  • Understanding of health and wellness marketplace and employer trends.
  • Strong verbal and written communication skills, including ability to discuss medical needs with members and coordinate with staff, vendors, and community resources.
  • Analytical experience including medical data analysis.
  • PC proficiency (Word, Excel, PowerPoint, databases, and web-based applications).
  • Current driver's license, reliable transportation, and applicable insurance.
  • Ability and willingness to travel within assigned territory.

 
Preferred Qualifications:

• 3 years of clinical experience.
• Experience in patient education.
• Background in condition management.
• Bilingual in English and Spanish.
• Transition of Care experience.
• Experience managing complex or catastrophic cases.
• Certification in Case Management, Training, Project Management, or a nationally recognized health care certification.