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Medical Management Specialist
2 weeks ago
BKG Enterprises is seeking Medical Management Specialist to join our team This is a work-from home opportunity
Responsible for providing non-clinical support to medical management operations, which includes handling the most complex file reviews and inquiries from members and providers.
Primary duties may include but are not limited to:
- Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
- Conducts initial review of files to determine appropriate action required.
- Maintains and updates tracking databases.
- Prepares reports and documents all actions.
- Responds to requests, calls or correspondence within scope.
- Provides general program information to members and providers as requested.
- May review and assist with cases.
- May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
- Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. Provides mentoring and work direction to lower-level associates.
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Requires a high school diploma and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background. Knowledge of managed care or Medicaid/Medicare concepts strongly preferred.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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1 month ago
Indianapolis, United States Staff Management Full timeWith Staff Management | SMX, you'll get a weekly paycheck, learn new skills, meet new people, and work with a great management team in a clean and safe environment. Staff Management | SMX in Indianapolis, Indiana is hiring Industrial Sanitation Specialists to join our team. This is an entry-level, temp-to-hire position. We offer paid training, benefit...
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1 month ago
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