Medical Management Specialist I – Pediatric Care Coordination (Austin, TX) – Blue Cross Blue Shield of IL, MT, NM, OK & TX – Austin, TX

**This is a Telecommuter Field position – Austin, TX**

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 Texas (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:

  • RN experience.
  • Pediatric experience.
  • Home Health experience.
  • Field experience.
  • 3 years clinical experience.
  • Patient education experience.
  • Condition Management experience.
  • Bilingual in English and Spanish.
  • Experience in managing complex or catastrophic cases.
  • Case Management Field Work experience.
  • Prior MCO experience.
  • Prior experience working with state waiver programs.
  • Certification in Case Management, Training, Project Management or nationally recognized health care certification.

#LI-Remote

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.

Expertise

Nursing

Job Type

Full-Time Regular

Location

TX – Austin

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC’s Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to “my account” and click on “View your job submissions”.

Source: Indeed.com
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