Medical Management Specialist II

3 days ago


Topeka, Kansas, United States Elevance Health Full time
Job Summary

We are seeking a highly skilled Medical Management Specialist II to join our team at Elevance Health. As a key member of our medical management operations, you will provide non-clinical support to our medical management teams, handling complex file reviews and inquiries from members and providers.

Key Responsibilities
  • Case Review and Management: Gather clinical information, determine the appropriate area to refer or assign cases, and conduct initial reviews to determine the required action.
  • Tracking and Reporting: Maintain and update tracking databases, prepare reports, and document all actions.
  • Communication and Liaison: Respond to requests, calls, or correspondence within scope, provide general program information to members and providers, and act as a liaison between medical management operations and other internal departments.
  • Case Referral and Coordination: Assist with case referral processes, collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager, and track referrals according to specified timelines.
Requirements
  • Education and Experience: 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.
Work Environment

This is a hybrid role that requires working at an Elevance Health location at least once per week, and potentially several times per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

What We Offer

Elevance Health is a health company dedicated to improving lives and communities. We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.



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