Registered Nurse with three years of direct clinical care to consumers in a clinical setting, or Licensed Professional Counselor or Licensed Master Social Worker with the stated clinical-practice pathway to licensure.
Hold a current, valid, unrestricted license in the state of operations or qualify through reciprocity; compact licensees changing permanent residence must obtain active, unrestricted registered nurse licensure in the state of operations within 90 days of hire.
Have three years of wellness or managed care experience presenting clinical issues to members and physicians.
Have knowledge of the health and wellness marketplace and employer trends.
Have verbal and written communication skills for discussing medical needs with members and interfacing with internal staff, management, external vendors, and community resources.
Have analytical experience, including medical data analysis.
Be proficient with personal computers, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, databases, and web-based applications.
Responsibilities
Conduct 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.
Desired Qualifications
Three years of clinical experience.
Patient education experience.
Condition management experience.
Bilingual ability in English and Spanish.
Transition of care experience.
Experience managing complex or catastrophic cases.
Certification in case management, training, project management, or a nationally recognized health care certification.
Fully Remote
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. * 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.