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Medical Management Specialist
2 months ago
We are seeking a highly skilled Medical Management Specialist I to join our team at PSG Global Solutions Careers. As a Medical Management Specialist I, 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.
- 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), which includes 2 years of clinical practice to obtain their LPC or LMSW license.
- Current, valid, unrestricted license in the state of operations (or reciprocity).
- Plus 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.
- 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.
