Medical Mgmt Specialist I

Hcsc Waco , TX 76701

Posted 2 days ago

Job ID: SH-1036312

Description:

We are the Health Care Management division of HCSC a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.

We're also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.

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), 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 direct clinical care to the consumer in a clinical setting.

  • 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.

  • Experience in managing complex or catastrophic cases.

  • Certification in Case Management, Training, Project Management or nationally recognized health care certification.

  • CA

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:

Expertise Nursing Job Type Full-Time Regular Location TX - Temple, TX - Waco, TX - Kileen


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Medical Mgmt Specialist I

Hcsc