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Medical Management Specialist

2 months ago

Santa Fe, New Mexico, United States Health Care Service Corporation Full time
Job Summary

This position is responsible for conducting medical management and health education programs for customers on government health care programs. Key accountabilities include gathering, analyzing, and providing data for regulatory reports. The successful candidate will perform assessments, care planning, and care coordination in the member/family home and telephonically. This role will represent the company to members, providers, and state regulators.

Key Responsibilities
  • Conduct medical management and health education programs for customers on government health care programs
  • Gather, analyze, and provide data for regulatory reports
  • Perform assessments, care planning, and care coordination in the member/family home and telephonically
  • Represent the company to members, providers, and state regulators
Requirements
  • Registered Nurse (RN), Licensed Professional Counselor (LPC), Licensed Clinical Professional Counselor (LCPC), Licensed Master Social Worker (LMSW), Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW) OR Licensed Mental Health Counselor (LMHC) with 2 years direct clinical care to the consumer in a clinical setting
  • Current, valid, unrestricted license in the state of operations (or reciprocity)
  • 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, including Word, Excel, and PowerPoint, database experience, and Web-based applications
  • Current unrestricted driver's license, transportation, and applicable insurance
  • Ability and willingness to travel within assigned territory
Preferred Qualifications
  • Plus 1 year wellness or managed care experience
  • 3 years clinical experience
  • Patient education experience
  • Condition Management experience
  • Bilingual in English and Spanish
  • Experience in managing complex or catastrophic cases
  • Certification in Case Management, Training, Project Management, or nationally recognized healthcare certification
HCSC Employment Statement

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.