Medical Management Specialist II
3 days ago
We are seeking a highly skilled Medical Management Specialist II to join our team at Elevance Health. This is a hybrid role that will work in a remote and office setting, with the ideal candidate living within 50 miles of our Topeka, Kansas location.
Key Responsibilities- Provide non-clinical support to medical management operations, including handling complex file reviews and inquiries from members and providers.
- Gather clinical information regarding cases and determine the appropriate area to refer or assign the case.
- Conduct initial reviews of files to determine the appropriate action required and maintain and update tracking databases.
- Prepare reports and documents all actions, and respond to requests, calls, or correspondence within scope.
- Provide general program information to members and providers as requested, and may review and assist with cases.
- Act 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.
- 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.
- Knowledge of managed care or Medicaid/Medicare concepts is strongly preferred.
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
This is a hybrid role that will work in a remote and office setting, with the ideal candidate living within 50 miles of our Topeka, Kansas location. Elevance Health operates in a Hybrid Workforce Strategy, and associates are required to work at an Elevance Health location at least once per week.
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