Medical Management Specialist

2 weeks ago


Detroit, United States Walker Healthforce Full time

Remote position but must be local to New Mexico - Contract to Hire


This position is responsible for conducting medical management and health education programs for customers on government health care programs. The role involves gathering, analyzing, and providing data for regulatory reports, as well as performing care assessments, care planning, and care coordination in both the member’s home and via telephonic outreach. You will represent the company to members and collaborate with healthcare providers to ensure high-quality, comprehensive care.



KEY RESPONSIBILITIES:

  • Conduct medical management and health education programs for customers enrolled in government health care programs.
  • Analyze and report data for regulatory compliance.
  • Perform care assessments, care planning, and care coordination both in-person (in the member’s home) and via phone.
  • Represent the company professionally in interactions with members, physicians, and community resources.
  • Address the medical needs of members and coordinate services to ensure appropriate care.



JOB REQUIREMENTS

Licensure:

  • Registered Nurse (RN) with at least 3 years of direct clinical care in a healthcare setting; OR
  • Licensed Professional Counselor (LPC) or Licensed Master Social Worker (LMSW) with 2 years of clinical practice.
  • Must hold a valid, unrestricted license in the state of operations (or reciprocity).
  • Compact license holders must obtain an active, unrestricted RN license in the state of operations within 90 days of hire.

Experience:

  • 3+ years of experience in wellness or managed care, particularly in presenting clinical issues to members and physicians.
  • Proficient in verbal and written communication, including discussing medical needs with members and interfacing with internal teams, external vendors, and community resources.
  • Strong analytical skills with a focus on medical data analysis.
  • Proficiency in PC applications, including Word, Excel, PowerPoint, and web-based tools or databases.


Contact our Recruiting Team today to experience the Walker Healthforce difference


ABOUT US

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today


We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.


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