Medical Management Specialist

Job Title: Medical Management Specialist I (RN) Job Summary In this role, you will: Review daily inpatient reports to assess member health conditions, including pregnancy and postpartum cases. Identify care coordination needs and support transitions of care. Coordinate with delegates using healthcare platforms and state portals. Support provider communications and respond to care coordination inquiries. Assist with onboarding, training, delegation oversight, compliance monitoring, and reporting. Analyze healthcare data and support regulatory reporting initiatives. Collaborate with internal teams to improve medical management and health education programs for government healthcare members. Required Qualifications Active, unrestricted Registered Nurse (RN) license. Minimum 3 years of direct clinical nursing experience . At least 3 years of wellness or managed care experience working with members and physicians. Strong clinical assessment, communication, and analytical skills. Experience with Microsoft Office (Word, Excel, PowerPoint) and web-based applications. Valid driver's license and reliable transportation. Ability to travel within the assigned territory if needed. Preferred Qualifications Transition of Care or Condition Management experience. Experience managing complex or catastrophic cases. Case Management or Project Management certification. #J-18808-Ljbffr