Medical Management Specialist I 29926 at Solving IT

One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!

This contract role as a Medical Management Specialist I in Downers Grove, IL is responsible for conducting medical management and health education programs for customers on government health care programs.

Responsibilities:

•       Conducting medical management and health education programs for customers on government health care programs.

•       Gathering, analyzing and providing date for regulatory reports.

•       This position will represent the company to members.

Requirements:

•       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 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 Requirements:

•       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.

Benefits: 

Solving IT, a Woman and LGBTQ+ owned and operated organization is thrilled to provide a comprehensive benefit package to all our W2 employees and their families, regardless of gender. We are proud to offer five diverse health plan options as well as a PPO dental plan through Blue Cross Blue Shield, Term Life/AD&D Insurance, and a 401(k) Savings Plan. Solving IT covers a portion of the health and dental premiums for our employees. 

As you progress in your professional journey, Solving IT is dedicated to accommodating your evolving preferences and matching you with fulfilling projects. We champion equality and embrace diversity in all its forms. Creating an atmosphere that encourages varied perspectives to collaborate fosters personal development, strengthens team unity, and contributes to the overall success of the organization! 

Whether you're seeking your next career challenge or aiming to stay abreast of industry trends, Solving IT is committed to supporting your career advancement. We actively encourage applications from all backgrounds and utilize the most up-to-date market insights and compensation data to ensure that you receive not just advice, but the complete Solving IT Experience.