Job Description

We're Hiring: Medical Management Specialist!
We are seeking an experienced Medical Management Specialist to oversee healthcare operations, ensure compliance with medical regulations, and optimize patient care delivery.
Location: Central Albuquerque, NM
Work Mode: On-site
Role: Medical Management Specialist
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 data for regulatory reports. This position will represent the company to members.
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 licensees 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.
Good to have:
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.

Job Tags

Permanent employment,

Similar Jobs

Chipton‑Ross Inc

216547 - Embedded Software Engineer Job at Chipton‑Ross Inc

Chipton-Ross is seeking a Embedded Software Engineer for a contract opportunity in Sunnyvale, CA. BASIC QUALIFICATIONS (REQUIRED SKILLS/EXPERIENCE):~Experience with programming languages such as C, ~C++Standard teaming: Ability to work with multi-disciplined...

Justgot2Haveit

Data Entry Typist Job at Justgot2Haveit

Just Got 2 Have It! is seeking a highly accurate and efficient Data Entry Typist to input, update, and maintain company data. The ideal candidate will have strong typing skills, excellent attention to detail, and the ability to meet productivity targets while maintaining...

UnityPoint Health

Patient Sitter Float - Downtown Job at UnityPoint Health

...Area of Interest: Patient Care FTE/Hours per pay period: 0.9 Department: Nursing Admin- Downtown Shift: Days 0700-1930 Job ID: 176459 Overview Full Time (36 hours per week); Days 7am-7:30pm To provide additional assistance to keep identified patients safe from...

Ausherman Painting

Receptionist/Office Assistant Job at Ausherman Painting

Position Summary: We are seeking an organized, detail-oriented, and proactive Receptionist/Office Assistant to join our team. This multifaceted role requires you to be the first point of contact for customers and vendors, manage appointments, provide clerical support...

Curogram

Content Writer Job at Curogram

...Responsibilities: Produce well-researched content for publication online and in print. Organize writing schedules to complete drafts of content or finished projects within deadlines. Develop related content for multiple platforms, such as websites, email marketing...

Medical Management Nurse Job at Tap Growth ai, Albuquerque, NM

Zi82T09sZjM3ekNHZ2YrQ2V3c0RBUDlyR0E9PQ==