Medical Management Specialist

4 weeks ago


Albuquerque, 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

The ideal candidate will possess a 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 of direct clinical care to the consumer in a clinical setting. A current, valid, unrestricted license in the state of operations (or reciprocity) is also required. Additionally, the candidate should have knowledge of the health and wellness marketplace and employer trends, as well as verbal and written communication skills.

The successful candidate will also have analytical experience, including medical data analysis, and proficiency in PC applications such as Word, Excel, and PowerPoint. A current unrestricted driver's license, transportation, and applicable insurance are also required. Ability and willingness to travel within assigned territory are essential.

Preferred Qualifications

Plus 1 year of wellness or managed care experience, 3 years of clinical experience, patient education experience, condition management experience, bilingual in English and Spanish, experience in managing complex or catastrophic cases, and certification in Case Management, Training, Project Management, or nationally recognized healthcare certification are preferred.


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