Medical Management Specialist
2 weeks ago
Absolute Staffing is searching for a Medical Management Specialist to work with our client.
Job Location: Providence, RI
Medical Management Specialist I
The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to:
- Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
- Provides information regarding network providers or general program information when requested.
- May assist with complex cases.
- May act as liaison between Medical Management and/or Operations and internal departments.
- Maintains and updates tracking databases.
- Prepares reports and documents all actions.
- Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Minimum Requirements:
- 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.
Preferred Skills, Capabilities and Experiences:
- Strong working knowledge of Microsoft office products (especially Excel and Teams) strongly preferred.
- Understanding of managed care or Medicaid/Medicare strongly preferred.
For URAC accredited areas, the following professional competencies apply:
- Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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