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Healthcare Specialist
2 months ago
About the Role
We are seeking a skilled Medical Management Professional to join our team at PSG Global Solutions Careers. As a Medical Management Professional, you will play a critical role in managing special needs children and their families, conducting health assessments, and providing medical management and health education programs for customers on government health care programs.
Key Responsibilities
- Manage special needs children and their families, providing support and guidance to ensure optimal health outcomes.
- Conduct health assessments in members' homes, gathering information to inform medical management decisions.
- Develop and implement medical management and health education programs for customers on government health care programs, promoting healthy behaviors and disease prevention.
- Analyze and provide data for regulatory reports, ensuring compliance with industry standards.
- Represent the company to members, building strong relationships and providing exceptional customer service.
Requirements
- 3 years of experience in wellness or managed care, with a strong background in presenting clinical issues to members and physicians.
- Registered Nurse (RN) with 3 years of direct clinical care experience, or Licensed Professional Counselor (LPC) or Licensed Master Social Worker (LMSW) with 2 years of clinical practice experience.
- Current, valid, unrestricted license in the state of operations (or reciprocity).
- Knowledge of the health and wellness marketplace and employer trends.
- Excellent verbal and written communication skills, with the ability to discuss medical needs with members and interface with internal staff/management and external vendors and community resources.
- Analytical experience, including medical data analysis.
- Current driver's license, transportation, and applicable insurance.
- 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 healthcare certification.
