Medical Management Specialist I
Elevance Health•Cincinnati, OH
•Remote
About The Position
This role enables associates to work virtually full-time, with the exception of 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. 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.
- Proficient in Microsoft Office applications (Outlook, Teams, Word, Excel).
Nice To Haves
- Understanding of managed care or Medicaid/Medicare strongly preferred.
Responsibilities
- Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review), including triaging information from the shared mailbox.
- 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.
- Scheduling of Peer-to-Peers to facilitate Medical Director discussions with providers.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
