Medical Management Specialist I

Summary
The Case Manager / Care Coordinator plays a critical role in supporting members in their homes to promote independence, enhance quality of life, and prevent unnecessary long-term institutional care. This position requires regular in?person visits, detailed assessments, and close collaboration with members, caregivers, healthcare providers, and community resources.

Key Responsibilities

• Conduct in?person home visits to assess member needs, monitor progress, and provide care coordination.
• Complete comprehensive initial assessments and develop individualized care plans in collaboration with members, caregivers, and providers.
• Educate members on available community services and support informed provider selection.
• Submit care plans for state approval, obtain required member signatures, and ensure program compliance.
• Provide ongoing case management, follow?up, and documentation in accordance with state requirements.
• Manage an increasing caseload, achieving full productivity within 3–4 months of hire.
• Coordinate care with internal teams, healthcare providers, vendors, and community resources.
• Handle cases aligned with experience level, escalating higher?acuity or complex cases as appropriate.
• Maintain accurate, timely, and compliant documentation within a highly regulated environment.

Required

• Current, valid, and unrestricted licensure as one of the following:
  • Registered Nurse (RN)
  • Licensed Professional Counselor (LPC)
  • Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW)
• Minimum 2 years of wellness, managed care, home health, or related clinical experience involving direct member and physician interaction.
• Strong verbal and written communication skills, including the ability to discuss medical needs with members and collaborate with internal teams, management, vendors, and community partners.
• Proven ability to manage caseloads independently and work effectively in the field.
• PC proficiency, including Microsoft Word, Excel, and PowerPoint; experience with databases and web-based tools.
• Ability to achieve a passing score on an internal online Excel assessment.

Preferred

• Minimum 3 years of clinical experience
• Demonstrated patient education experience
• Experience with condition management and chronic disease support
• Bilingual in English and Spanish
• Experience with Transitions of Care (e.g., hospital to home, facility to community)
• Proven experience managing complex or catastrophic cases
• Certification in one or more of the following is preferred:
  • Case Management
  • Training
  • Project Management
  • A nationally recognized healthcare certification