Medical Management Specialist I

W3R Consulting; Rockford (IL); Hybrid; USD 65,000 - 90,000; Full time

Job summary

W3R Consulting in Rockford, IL seeks a qualified healthcare professional to conduct medical management and health education programs for government health care clients. The role includes gathering and analyzing data for regulatory reports and representing the company to members.

Must have an RN license with 3 years direct clinical care or LPC/LMSW with 2 years’ clinical practice, plus current unrestricted licensure in the operating state.

Qualifications

• RN with 3 years direct clinical care, or LPC/LMSW with 2 years clinical practice.
• Current, valid, unrestricted license in state of operations; reciprocity allowed.
• 3 years wellness or managed care experience presenting clinical issues to members/physicians.
• Knowledge of health and wellness marketplace and employer trends.
• Verbal and written communication skills and ability to discuss medical needs with members.
• Analytical experience including medical data analysis.
• Valid driver's license and willingness to travel within territory.
• PC skills: Word, Excel, PowerPoint; database and web applications.

Responsibilities

• Conduct medical management and health education programs for government health care clients.
• Gather, analyze and provide data for regulatory reports.
• Represent the company to members.

Skills

RN clinical care

LPC/LMSW license

Communication skills

Data analysis

Travel willingness

PC skills

Job description

Job 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.