Medical Management Specialist I

Elevance Health•Tampa, FL

21h•Remote

About The Position

The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. The ideal candidate will be located near one of the following Pulsepoints: Tampa, FL or Miami, FL. 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.

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

Understanding of managed care or Medicaid/Medicare strongly preferred.
Previous experience in healthcare industry and customer service is preferred.
Previous experience working with prior-authorizations, case management, and/or utilization management is highly preferred.
Bilingual (English and Spanish) is a huge plus.
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.