Medical Management Specialist I
Reference Code: 4953
Position: Medical Management Specialist I, HCSCJP00012946
Duration: 3-6 months Contract to Hire
Location Address: Downers Grove, Illinois 60515
Update 3/2/2021: Looking for candidates with one year of MCO experience that is interested in Medical Management Specialist positions. Candidates must have waiver experience.
Candidates need at least one year of waiver services, and some MCO experience for case management
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.
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.
*Registered Nurse (RN), LCSW, LCPC, and would also consider LSW and LPC
* 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.