Medical Management Specialist (Farmington, NM)

$53,498 - $118,082/Yr

Health Care Service Corporation - Farmington, NM

Full-time

Remote - Farmington, NM

Insurance Carriers and Related Activities

About the position

The Medical Management Specialist at HCSC is responsible for conducting medical management and health education programs for customers enrolled in government health care programs. This role involves gathering and analyzing data for regulatory reports, performing assessments, care planning, and care coordination both in members' homes and via telephone. The specialist will represent the company to members, providers, and state regulators, ensuring effective communication and support for health care needs.

Responsibilities

• Conduct medical management and health education programs for customers on government health care programs.
• Gather, analyze, and provide data for regulatory reports.
• Perform assessments, care planning, and care coordination in the member/family home and telephonically.
• Represent the company to members, providers, and state regulators.

Requirements

• Registered Nurse (RN), Licensed Professional Counselor (LPC), Licensed Clinical Professional Counselor (LCPC), Licensed Master Social Worker (LMSW), Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW), or Licensed Mental Health Counselor (LMHC) with 2 years of direct clinical care experience.
• Current, valid, unrestricted license in the state of operations.
• Knowledge of the health and wellness marketplace and employer trends.
• Strong verbal and written communication skills.
• Analytical experience including medical data analysis.
• Proficiency in PC applications including Word, Excel, and PowerPoint, as well as database and web-based applications.
• Current unrestricted driver's license, transportation, and applicable insurance.
• Ability and willingness to travel within assigned territory.

Nice-to-haves

• 1 year of wellness or managed care experience.
• 3 years of clinical experience.
• Patient education experience.
• Condition management experience.
• Bilingual in English and Spanish.
• Experience in managing complex or catastrophic cases.
• Certification in Case Management, Training, Project Management, or nationally recognized health care certification.

Benefits

• Professional development opportunities.
• Work from home flexibility.