Medical Management Specialist II

4 weeks ago


Topeka, Kansas, United States Elevance Health Full time
Job Title: Medical Management Specialist II

We are seeking a highly skilled Medical Management Specialist II to join our team at Elevance Health. As a Medical Management Specialist II, you will play a critical role in providing non-clinical support to medical management operations, handling complex file reviews and inquiries from members and providers.

Key Responsibilities:
  • Gather clinical information regarding cases and determine the appropriate area to refer or assign the case.
  • Conduct initial reviews of files to determine the required action and maintain and update tracking databases.
  • Prepare reports and document all actions, responding to requests, calls, or correspondence within scope.
  • Provide general program information to members and providers as requested.
  • May review and assist with cases, acting as a liaison between medical management operations and other internal departments to support the administration of medical benefits.
  • May assist with case referral processes 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, complete and submit CCS referrals to local CCS programs, and track referrals according to specified timelines.
Requirements:
  • Requires a high school diploma and a minimum of 3 years of administrative and customer service experience, or any combination of education and experience that would provide an equivalent background.
Preferred Skills:
  • Knowledge of managed care or Medicaid/Medicare concepts is strongly preferred.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.



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