Medical Management Specialist

5 days ago


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

We are seeking a highly skilled Medical Management Specialist to join our team at Elevance Health. As a Medical Management Specialist, you will provide non-clinical support to the Medical Management and/or Operations areas, ensuring the delivery of high-quality healthcare services to our members.

Key Responsibilities
  • Gather clinical information regarding cases and determine the appropriate area to refer or assign cases (utilization management, case management, QI, Med Review).
  • Provide information regarding network providers or general program information when requested.
  • Assist with complex cases and act as a liaison between Medical Management and/or Operations and internal departments.
  • Maintain and update tracking databases and prepare reports and documents all actions.
  • Ensure compliance with all relevant federal, state, and local laws and regulations.
Requirements
  • Requires a H.S. diploma or equivalent and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background.
  • Understanding of managed care or Medicaid/Medicare strongly preferred.
  • Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
What We Offer

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.

Work Environment

We operate 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. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.



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