Medical Management Specialist I

Elevance Health • Waukesha, WI

5d • Remote

About The Position

The Medical Management Specialist I provides non-clinical support to Medical Management and/or Operations. The role gathers clinical information about cases and determines the appropriate area for referral or assignment, such as utilization management, case management, quality improvement, or medical review. It also provides information about network providers and programs, responds to provider inquiries related to authorizations, may assist with complex cases, and may serve as a liaison between Medical Management and/or Operations and internal departments. The position maintains tracking databases, prepares reports, and documents actions. It does not conduct utilization management reviews that require interpretation of clinical information.

The role is virtually full-time, except for required in-person training sessions, and candidates must live within a reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. The schedule is an eight-hour shift, 8:00 a.m. to 5:00 p.m. Central Time, Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Requirements

• High school diploma or equivalent, and at least one year of experience, or an equivalent combination of education and experience.
• For URAC-accredited areas, strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are expected.

Nice To Haves

• Understanding of managed care or Medicaid/Medicare is strongly preferred.
• Previous experience in the healthcare industry and customer service is a plus.
• An associate degree in Arts or Science is preferred.
• One year of experience working with authorizations is desired.
• Previous experience working with LTSS members or Medicaid is strongly preferred.

Responsibilities

• Gather clinical information regarding cases and determine the appropriate area for referral or assignment, such as utilization management, case management, quality improvement, or medical review.
• Provide information about network providers or general programs when requested.
• Interact regularly with providers regarding authorization-related inquiries.
• Assist with complex cases as needed.
• Act as a liaison between Medical Management and/or Operations and internal departments as needed.
• Maintain and update tracking databases.
• Prepare reports and document all actions.
• Do not conduct utilization management review activities requiring interpretation of clinical information.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short- and long-term disability benefits
• 401(k) with match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED