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Medical Management Specialist

4 months ago

Downers Grove, United States PSG Global Solutions Careers Full time

Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
We're looking for a Medical Management Specialist, working in Insurance industry in Downers Grove, Illinois, United States.

  • Conduct medical management and health education programs for customers on government health care programs.
  • Gather, analyze and provide date for regulatory reports.
  • Represent the company to members.

Our Client

Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth.

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.

Big enough to have great opportunities. Small enough to care about finding the right one for you.

It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?

Experience Required for Your Success
  • Registered Nurse (RN), with 3 years direct clinical care to the consumer in a clinical setting or Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW), which includes 2 years of clinical practice to obtain their LPC or LMSW license
  • 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
  • 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 IL driver's license, transportation and applicable insurance (for IL)
  • Ability and willingness to travel within assigned territory
  • PC proficiency to include Word, Excel, and 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

What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?