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Medical Management Specialist

2 months ago

Quincy, Illinois, United States PSG Global Solutions Careers Full time
Medical Management Specialist

At PSG Global Solutions Careers, we're seeking a highly skilled Medical Management Specialist to join our team. 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.

  • Develop and implement medical management programs to improve health outcomes and reduce costs.
  • Analyze and provide data for regulatory reports to ensure compliance with industry standards.
  • Represent the company to members, providing exceptional customer service and support.
About Our Client

Our client is a fast-growing industry-recognized staffing firm with 20+ years of experience and a strong reputation for connecting top talent with premier organizations. With a focus on relationships and mutual interest, we strive to create long-lasting partnerships and growth opportunities.

Experience Required for Success
  • Registered Nurse (RN), Licensed Professional Counselor (LCPC), or Licensed Master Social Worker (LMSW) with 2 years direct clinical care to the consumer in a clinical setting.
  • Current, valid, unrestricted license in the state of operations (or reciprocity).
  • 3+ years wellness or managed care experience presenting clinical issues with members/physicians.
  • 3 years clinical experience preferred.
  • Patient education experience preferred.
  • Condition Management experience preferred.
  • Bilingual in English and Spanish preferred.
  • Experience in managing complex or catastrophic cases preferred.
  • Certification in Case Management, Training, Project Management or nationally recognized healthcare certification preferred.
  • 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.