Medical Management Specialist II
2 months ago
We are seeking a highly skilled Medical Management Specialist II to provide non-clinical support to our medical management operations. This role involves handling complex file reviews and inquiries from members and providers, requiring strong analytical and problem-solving skills.
Key Responsibilities- File Review and Analysis: Gather clinical information, determine appropriate areas to refer or assign cases, and conduct initial reviews to determine required actions.
- Database Maintenance: Maintain and update tracking databases to ensure accurate and timely information.
- Reporting and Documentation: Prepare reports and document all actions, ensuring compliance with regulatory requirements.
- Communication and Liaison: Provide general program information to members and providers, and act as a liaison between medical management operations and other internal departments.
- Case Management: May review and assist with cases, and collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.
- Education and Experience: Requires a high school diploma and a minimum of 3 years administrative and customer service experience, or any combination of education and experience that provides an equivalent background.
- Preferred Skills: Knowledge of managed care or Medicaid/Medicare concepts is strongly preferred.
Elevance 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.
We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also provide medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
Elevance Health operates in a Hybrid Workforce Strategy, requiring associates to work 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.
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