Medical Management Specialist

4 weeks ago


Louisville, Kentucky, United States Elevance Health Full time

Job Summary:

The Medical Management Specialist I role is a key position within Elevance Health, providing non-clinical support to the Medical Management and/or Operations areas.

Key Responsibilities:

  • Gather clinical information regarding cases and determine the appropriate area to refer or assign the case.
  • 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.
  • Responsibilities exclude conducting any utilization management review activities that require interpretation of clinical information.

Requirements:

A high school diploma or equivalent and a minimum of 1 year of experience or any combination of education and experience that would provide an equivalent background are required.

Preferred Skills:

  • Understanding of managed care or Medicaid/Medicare is strongly preferred.
  • Experience interacting confidently with key stakeholders, as a subject matter expert, and comfortable with influencing decision-making is preferred.
  • Excellent written, oral, presentation, and interpersonal communication skills, with the proven ability to negotiate expectations between multiple parties, are preferred.
  • Proficiency in Microsoft Office products, most notably expertise in Word, Excel, PowerPoint, Teams, and Outlook, is preferred.

About Elevance Health:

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

What We Offer:

A range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Work Environment:

Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Elevance Health is an Equal Employment Opportunity employer.



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