Medical Management Specialist

Job Title: Medical Management Specialist I (RN)

In this role, you will:

• Review daily inpatient reports to assess member health conditions, including pregnancy and postpartum cases.
• Identify care coordination needs and support transitions of care.
• Coordinate with delegates using healthcare platforms and state portals.
• Support provider communications and respond to care coordination inquiries.
• Assist with onboarding, training, delegation oversight, compliance monitoring, and reporting.
• Analyze healthcare data and support regulatory reporting initiatives.
• Collaborate with internal teams to improve medical management and health education programs for government healthcare members.

• Active, unrestricted Registered Nurse (RN) license.
• Minimum 3 years of direct clinical nursing experience
  .
• At least 3 years of wellness or managed care experience working with members and physicians.
• Strong clinical assessment, communication, and analytical skills.
• Experience with Microsoft Office (Word, Excel, PowerPoint) and web-based applications.
• Valid driver's license and reliable transportation.
• Ability to travel within the assigned territory if needed.

• Transition of Care or Condition Management experience.
• Experience managing complex or catastrophic cases.
• Case Management or Project Management certification.