Medical Management Specialist I

Job Title: Care Manager – Government Programs
Location: Hybrid, Rock Island, IL. 
Job Type: W2 Contract
Expected Hours per Week: 40
Schedule: Monday–Friday
Pay Range: $36-38 per hour

Position Description:

This position is responsible for conducting medical management and health education programs for members enrolled in government healthcare programs. The role includes analyzing clinical data, supporting regulatory reporting, and representing the company through direct member engagement and care coordination.

Key Responsibilities:

• Conduct medical management and health education programs for members.
• Analyze and interpret clinical and utilization data for reporting.
• Support regulatory reporting requirements and documentation.
• Communicate with members, providers, and care teams to coordinate care.
• Educate members on medical needs, treatment plans, and wellness programs.
• Collaborate with internal teams and external vendors/resources.
• Manage caseloads including complex and/or high-risk members.
• Travel within assigned territory as needed.

Required Qualifications:

• RN, LPC, or LMSW with active, unrestricted license.
• 3+ years of direct clinical experience.
• 3+ years of managed care or wellness experience.
• Experience presenting clinical issues to members and physicians.
• Strong communication and interpersonal skills.
• Experience with medical data analysis and reporting.
• Proficiency in Microsoft Office (Word, Excel, PowerPoint) and web-based systems.
• Valid driver’s license, reliable transportation, and insurance.
• Ability to travel within assigned territory.

Preferred Qualifications:

• Patient education experience.
• Condition management experience.
• Transition of care experience.
• Experience managing complex or catastrophic cases.
• Bilingual (English/Spanish).
• Case Management or healthcare-related certification.

Top Skills:

• Case Management
• Managed Care
• Clinical Assessment
• Member Education
• Medical Data Analysis
• Care Coordination
• Communication Skills
• Regulatory Reporting