Medical Management Specialist (Non-Clinical) Remote

Professional Management Enterprises • Indianapolis, IN

57d • Remote

About The Position

BKG is seeking a Medical Management Specialist (Non-Clinical) to provide non-clinical support to the medical management or operations area. The specialist executes case management activities such as telephonic member screening, care planning and implementation, service coordination, monitoring and follow-up, reassessment, case conferencing, crisis intervention, and case closure. The primary focus is receiving inbound member case management calls, screening and triaging member needs, providing appropriate community and other resources, referring members to clinical case managers, and returning voicemail calls on the case management line. The role also reviews case records and gathers information to determine the appropriate department or area for case assignment. The position is a long-term contract paying $19.00 per hour, with one opening. It is remote, but candidates must reside in Indiana within 50 miles of Indianapolis. The schedule is Monday through Friday, 8 a.m. to 5 p.m. The role is referred to as MMS through WO.

Requirements

• High school diploma or equivalent required.
• Strong organizational and communication skills.
• Strong computer skills.
• Must reside in Indiana within 50 miles of Indianapolis.

Nice To Haves

• At least one year of relevant experience in managed care, Medicaid/Medicare, or a related field preferred.

Responsibilities

• Monitor and manage the inbound case management phone queue, return voicemails, screen and triage member needs, and assist with non-clinical support needs.
• Gather information about members or cases and determine the appropriate area for referral or assignment, including utilization management, case management, QI, or Med Review.
• Provide members with information about in-network providers or general program information when requested.
• Provide appropriate resources to members.
• Assist with complex cases as needed.
• Act as a liaison between Case Management and other internal departments as needed.
• Maintain and update tracking databases as indicated.
• Prepare reports and document actions as indicated.
• Do not conduct utilization management review activities or other clinical duties requiring interpretation of clinical information.

What This Job Offers

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