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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.
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
ATS Keywords
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Soft Skills
Interpersonal CommunicationAnalytical SkillsFacilitation Skills