Medical Management Specialist I

Elevance Health • Tampa, FL

14d • Hybrid

About The Position

Medical Management Specialist I - Medical Ops & Support (Non-Licensed) Locations: Tampa, FL Hybrid 1 : This role requires associates to be in-office 1-2 days a week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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. Schedule : Monday – Friday, 8:00AM – 5:00PM Eastern Time 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.
• Understanding of managed care or Medicaid/Medicare strongly preferred.
• For URAC accredited areas, the following professional competencies apply:

Nice To Haves

• Bilingual English/Spanish highly preferred.
• Comprehensive knowledge of current HEDIS specifications is highly preferred.
• Strong multitask skills is preferred.
• Proficiency in Microsoft Office products is 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

• 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.

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