Medical Management Specialist I

Job Description This position is responsible for conducting medical management and health education programs for customers on government health care programs. The role will include gathering, analyzing and providing date for regulatory reports. This position will represent the company to members. Job Qualifications Registered Nurse (RN) with 3 years of direct clinical care in a clinical setting or Licensed Professional Counselor (LPC) or Licensed Master Social Worker (LMSW) with 2 years of clinical practice to obtain the license. Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure 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, PowerPoint, database experience and web‑based applications. Preferred Job Qualifications 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. #J-18808-Ljbffr