Medical Management Specialist

1 day ago


Waukegan, Illinois, United States PSG Global Solutions Careers Full time
Medical Management Specialist Job Description

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)
  • 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


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