Medical Management Specialist II

14 hours ago

Wichita Falls, Texas, 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. 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.
Requirements
  • High school diploma and a minimum of 3 years of 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.
What We Offer

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.

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