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Medical Management Specialist II
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 to determine the appropriate area to refer or assign cases.
- Conduct initial reviews of files to determine the required action.
- Maintain and update tracking databases.
- Prepare reports and document all actions.
- Respond to requests, calls, or correspondence within scope.
- Provide general program information to members and providers as requested.
- May review and assist with cases.
- Act as a liaison between medical management operations and other internal departments to support ease of administration of medical benefits.
- May assist with case referral process.
- May 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 administrative and customer service experience.
- 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.
Elevance Health offers 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.
We operate in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19.
