Medical Management Specialist I

W3R Consulting; Chicago (IL); Hybrid; USD 70,000 - 90,000; Full time

Job summary

W3R Consulting seeks a nurse or licensed professional counselor to conduct medical management and health education programs for customers in government health care programs. The role includes data gathering and analysis for regulatory reports and representing the company to members.

Requirements include an active state license (RN or LPC/LMSW) and 3+ years of clinical/wellness experience, with willingness to travel within the territory. Proficiency with MS Office and databases is expected.

Qualifications

• RN, with 3 years direct clinical care to the consumer in a clinical setting or LPC/LMSW with equivalent experience.
• Current, valid, unrestricted license in the state of operations (or reciprocity); for compact licensees moving states, active, unrestricted RN licensure 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.

Responsibilities

• Conduce 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.

Skills

Verbal and written communication

Analytical experience

PC proficiency

Willingness to travel

Education

RN license (state of operation)

LPC or LMSW license

Tools

Word

Excel

PowerPoint

Database experience

Web-based applications

Job description

Description

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), 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.