Medical Management Specialist

3 days ago


Providence, Rhode Island, United States Absolute Staffing & Consulting Solutions Full time
Job Title: Medical Management Specialist

At Absolute Staffing & Consulting Solutions, we are seeking a highly skilled Medical Management Specialist to join our team. As a Medical Management Specialist, you will play a crucial role in providing non-clinical support to our client's Medical Management and Operations areas.

Key Responsibilities:
  • Gather clinical information regarding cases and determine the appropriate area to refer or assign the case (utilization management, case management, QI, Med Review).
  • Provide information regarding network providers or general program information when requested.
  • Assist with complex cases and act as a liaison between Medical Management and/or Operations and internal departments.
  • Maintain and update tracking databases, prepare reports, and document all actions.
Requirements:
  • A high school diploma and a minimum of 1 year of experience or any combination of education and experience that would provide an equivalent background.
  • Understanding of managed care or Medicaid/Medicare is strongly preferred.
Professional Competencies:
  • Strong oral, written, and interpersonal communication skills.
  • Problem-solving skills, facilitation skills, and analytical skills.


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