Medical Management Specialist I
About The Position
Medical Management Specialist I Location: Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, 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 an accommodation is granted as required by law. Work Shift: Monday – Friday, 8:00 am to 4:30 pm (PST) The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. 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. Outreaches to providers and members.
Requirements
- Requires a H.S. diploma or equivalent and a minimum of 1 year of experience in customer service or in healthcare or any combination of education and experience which would provide an equivalent background.
Nice To Haves
- Experience working in the behavioral health field.
- Understanding of managed care strongly preferred.
- Strong customer service and communication skills.
- Understanding of ACMP preferred but not necessary.
- 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.
- 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.
- Outreaches to providers and members.
Benefits
- In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
