Medical Management Specialist II

Elevance Health • Richmond, VA

6d • Remote

About The Position

The Medical Management Specialist II is r esponsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law. 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). Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases. Prepares reports and documents all actions. Responds to requests, calls or correspondence within scope. Provides general program information to members and providers as requested. May review and assist with cases. Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits. May assist with case referral process. May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

Requirements

• Requires a H.S. diploma or equivalent and a minimum of 3 years of administrative and customer service experience; or any combination of education and experience which would provide an equivalent background

Nice To Haves

• Knowledge of managed care or Medicaid/Medicare concepts is strongly preferred.

Responsibilities

• Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
• Conducts initial review of files to determine appropriate action required.
• Maintains and updates tracking databases.
• Prepares reports and documents all actions.
• Responds to requests, calls or correspondence within scope.
• Provides general program information to members and providers as requested.
• May review and assist with cases.
• Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.
• May assist with case referral process.
• May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

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: Mid Level
• Education Level: High school or GED