Medical Management Specialist II

2 weeks ago


Topeka, United States Elevance Health Full time

**Medical Management Specialist II****Location:** Kansas. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Topeka, Kansas Elevance Health PulsePoint location.The **Medical Management Specialist II** is responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.**How you will make an impact:**+ 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.+ Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.+ May assist with case referral process.+ May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.+ For California Children Services: May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition.+ Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals.+ Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.**Minimum Requirements:**+ Requires a high school diploma and a minimum of 3 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background.**Preferred Skills, Capabilities and Experiences:**+ Knowledge of managed care or Medicaid/Medicare concepts is 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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