Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.
Hours: Monday - Friday 8:00am to 4:30pm EST/CST.
The Medical Mgmt Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.
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).
- 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.
Minimum 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.
Preferred Skills, Capabilities, and Experiences:
- Understanding of managed care or Medicaid/Medicare strongly preferred.
- Experience interacting confidently with key stakeholders, as a subject matter expert and comfortable with influencing decision-making preferred.
- Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties preferred.
- Proficient of Microsoft Office products, most notably expertise in Word, Excel, PowerPoint, Teams, and Outlook.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Salary Information:
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $21.41 to $36.70.
Locations: District of Columbia (Washington, DC); Maryland; New York.
Benefits:
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
Company Overview:
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Equal Employment Opportunity:
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
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