Medical Management Specialist II

3 weeks ago

Woodland Hills, United States Elevance Health Full time

Medical Management Specialist II

Location : This position will work in a remote model. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

*Hours: Monday - Friday 8:00 AM - 5:00 PM PST with occasional weekends and/or holidays as needed

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 and act as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.

  • May assist with the case referral process and 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 the same date of identification of potential CCS eligible condition. Tracks referrals 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 that require the interpretation of clinical information.

Minimum Requirements:

  • Requires a high school diploma or equivalent.

  • Requires 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.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $23.14 to $38.02

Locations: California; Nevada; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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