Medical Management Specialist I

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Reference Code: 5251

Position: Medical Management Specialist I, HCSCJP00014300
Duration: 6 months Contract to Hire
Location Address: Albuquerque, New Mexico 87109

need candidates in Dona Ana County

Excel and Typing test scores should be added to the top of candidates' resume.
License # should be added to the top of candidates' resume.
City and State in which the candidate resides should be listed at the top of their resume.

This position is responsible for conducting medical management and health education programs for customers on government health care programs. This role will include gathering, analyzing and providing date for regulatory reports.
This position will represent the company to members.

JOB PURPOSE:
This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory reports. This position will represent the company to members.

JOB QUALIFICATIONS:
*Registered Nurse (RN), LCSW, or LCPC
* Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
* 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.

PREFERRED JOB 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 health care certification.

 

 

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