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Clinical Support Specialist
2 months ago
We are seeking a highly skilled Medical Management Specialist II to join our team at Elevance Health. This role will provide 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 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.
- 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.
- 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.
- Knowledge of managed care or Medicaid/Medicare concepts is strongly preferred.
This role will work in a hybrid model, with a mix of remote and office work. The ideal candidate will live within 50 miles of our Elevance Health location.
What We OfferWe 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.
About UsElevance Health is a health company dedicated to improving lives and communities. 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.
