Medical Management Specialist I

Elevance Health•Tampa, FL

12d•Remote

About The Position

Simply Healthcare Plans, Inc. is a proud member of the Elevance Health family of companies. We are a health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs. We’re working to help make health care simple, so members can focus on what matters most. The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

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.

Nice To Haves

Fully Bilingual (English & Spanish/Creole). Must be able to write, read and speak both languages in a proficiency level preferred.
Understanding of managed care or Medicaid/Medicare strongly preferred.
Previous experience in healthcare industry and customer service is a plus.
Previous experience working with LTSS members or Medicaid is strongly preferred.
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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.
Regularly interacts with providers regarding authorization related inquiries.
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.