Medical Management Specialist I

5 days ago


Chicago, Illinois, United States PSG Global Solutions Careers Full time
About the Role

We are seeking a highly skilled Medical Management Specialist I to join our team at PSG Global Solutions Careers. As a key member of our team, 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

To be successful in this role, you will need:

  • A Registered Nurse (RN) with 3 years of direct clinical care experience in a clinical setting or a Licensed Professional Counselor (LPC) or Licensed Master Social Worker (LMSW) with 2 years of clinical practice experience.
  • A current, valid, unrestricted license in the state of operations (or reciprocity).
  • Plus 3 years of 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.
  • A current IL driver's license, transportation, and applicable insurance (for IL).
  • Ability and willingness to travel within assigned territory.
  • PC proficiency, including Word, Excel, and PowerPoint, database experience, and Web-based applications.
Preferred Qualifications
  • 3 years of 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.


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