Medical Management Specialist I

• The Medical Management Specialist is responsible for conducting medical management and health education programs for members enrolled in government healthcare plans.
• This position gathers, analyzes, and reports data for regulatory compliance and serves as a key representative of the company to members, providers, and community resources.

Key Responsibilities:

• Conduct health education and medical management activities to support members’ clinical and wellness needs.
• Gather, analyze, and provide data for regulatory and internal reporting.
• Communicate and collaborate with physicians, members, and care teams to support care coordination.
• Represent the company to members and external partners in a professional and empathetic manner.
• Travel within the assigned territory as required.

Required Qualifications:

• Active, unrestricted RN, LPC, or LMSW license in the state of operation (or compact license).
• Minimum of 3 years of direct clinical experience (RN) or 2 years of post-licensure clinical practice (LPC/LMSW).
• 3+ years of experience in wellness, managed care, or case management.
• Strong analytical skills, including medical data analysis.
• Proficiency in Microsoft Word, Excel, PowerPoint, and web-based applications.
• Excellent communication skills (verbal and written).
• Current driver’s license, reliable transportation, and valid insurance.

Preferred Qualifications:

• Experience working with Traumatic Brain Injury (TBI) or HIV populations.
• 3 years of additional clinical experience.
• Experience in Condition Management or Transition of Care.
• Bilingual (English/Spanish) preferred.
• Certification in Case Management, Project Management, or other nationally recognized healthcare credential.