Medical Management Specialist I (Bilingual Spanish Preferred)
About The Position
The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. How you will make an impact: 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.
Requirements
- Requires a high school diploma.
- Minimum of 1 year experience or any combination of education and experience which would provide an equivalent background.
Nice To Haves
- Bilingual Spanish preferred
Responsibilities
- 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.
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
