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Medical Management Specialist I
1 month ago
The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. This role requires a high school diploma and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background. The ideal candidate will have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Key Responsibilities:
Gather clinical information regarding case and determine appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Provide information regarding network providers or general program information when requested.
Assist with complex cases.
Act as liaison between Medical Management and/or Operations and internal departments.
Maintain and update tracking databases.
Prepare reports and documents all actions.
Preferred Skills and Qualifications:
Understanding of managed care or Medicaid/Medicare strongly preferred.
Experience working in a hybrid model (remote and office) preferred.
About Elevance Health:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. 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.
Our Culture:
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. We operate in a Hybrid Workforce Strategy, and specific requirements and expectations for time onsite will be discussed as part of the hiring process.
Equal Employment Opportunity:
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.
