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Medical Management Specialist

2 months ago

Downers Grove, United States Health Care Service Corporation Full time

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This is a Union Role

Job Summary

This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing data for regulatory reports. Perform assessments, care planning and care coordination in the member/family home and telephonically. This position will represent the company to members, providers and state regulators.

Required Job Qualifications:

  • Registered Nurse (RN), Licensed Professional Counselor (LPC), Licensed Clinical Professional Counselor (LCPC), Licensed Master Social Worker (LMSW), Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW) OR Licensed Mental Health Counselor (LMHC) with 2 years direct clinical care to the consumer in a clinical setting.
  • 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.
  • 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.
  • PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications.
  • Current unrestricted driver's license, transportation and applicable insurance.
  • Ability and willingness to travel within assigned territory.

Preferred Job Qualifications:

  • Plus 1 year wellness or managed care experience
  • Telecommute work.
  • 3 years clinical experience.
  • Patient education experience.
  • Condition Management experience.
  • Bilingual in English and Spanish.
  • Experience in managing complex or catastrophic cases.
  • Certification in Case Management, Training, Project Management or nationally recognized health care certification.

*CA

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range $30.67 - $55.38