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Medical Management Specialist

2 months ago

Aurora, Colorado, United States PSG Global Solutions Careers Full time
Job Title: Medical Management Specialist

We are seeking a highly skilled Medical Management Specialist to join our team at PSG Global Solutions Careers. As a Medical Management Specialist, you will play a critical role in conducting medical management and health education programs for customers on government health care programs.

Key Responsibilities:
  • Conduct medical management and health education programs for customers on government health care programs.
  • Gather, analyze, and provide data for regulatory reports.
  • Represent the company to members.
Requirements:
  • 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).
  • 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 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 healthcare certification.