Medical Management Specialist

VIVA USA Inc; Downers Grove (IL); On-site; USD 68,000 - 98,000; Full time

Job summary

VIVA USA Inc. is seeking a qualified healthcare professional to conduct medical management and health education programs for customers enrolled in government health care programs. The role involves data gathering and analysis to support regulatory reporting.

The incumbent will represent the company to members, coordinate with physicians and internal teams, and travel within the assigned territory as required. Licensure requirements include RN, LPC, or LMSW with relevant clinical experience.

Qualifications

• RN or LPC/LMSW with required state licensure.
• 3 years wellness or managed care experience.
• Bilingual in English and Spanish (preferred).
• Transition of Care experience (preferred).

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 and external stakeholders.

Skills

Regulatory reporting

Clinical data analysis

Verbal & written communication

PC proficiency

Travel willingness

Education

RN license

LPC/LMSW license

Tools

Word

Excel

PowerPoint

Web-based applications

Job description

Behavioral health and physical health experience requested

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), 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). 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 driver's license, transportation and applicable insurance.
• 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.

Notes

This is a contract role with the possibility of conversion to full-time based on business needs and performance

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status