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Medical Management Specialist I
Elevance HealthMedical Management Specialist providing non-clinical support to Medical Management and Operations at Elevance Health. Gathers clinical information, interacts with providers, and maintains databases while excluding utilization management review activities.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in managing clinical information and facilitating communication between medical management and internal departments. Bilingual in English and Spanish/Creole, with a strong understanding of managed care and Medicaid/Medicare processes.
Highest-signal resume keywords
Bilingual Proficiency (English & Spanish/Creole)Understanding of Managed CareExperience in Healthcare IndustryStrong Communication SkillsProblem-Solving Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Soft Skills
Interpersonal CommunicationAnalytical SkillsFacilitation Skills
Tools & Technologies
Tracking Databases
Industry Keywords
Utilization ManagementCase ManagementQuality Improvement (QI)MedicaidMedicareLTSS MembersCustomer Service
About the role
Key responsibilities & impact- 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
- Regularly interacts with providers regarding authorization related inquiries
- 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
Requirements
What you’ll need- Requires a H.S. diploma or equivalent
- a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background
- Fully Bilingual (English & Spanish/Creole)
- Must be able to write, read and speak both languages in a proficiency level preferred
- Understanding of managed care or Medicaid/Medicare strongly preferred
- Previous experience in healthcare industry and customer service is a plus
- Previous experience working with LTSS members or Medicaid is strongly preferred
- strong oral, written and interpersonal communication skills
- problem-solving skills
- facilitation skills
- analytical skills
Benefits
Comp & perks- 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