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Elevance Health
Medical Management Specialist IElevance Health • Miami, FL, United States
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Medical Management Specialist I

Medical Management Specialist I

Elevance Health • Miami, FL, United States
13 days ago
Job type
  • Full-time
Job description

Medical Management Specialist I

Medical Management Specialist I

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, 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 an accommodation is granted as required by law.

The Medical Management 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), including triaging information from the shared mailbox.
  • 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.
  • Scheduling of Peer-to-Peers to facilitate Medical Director discussions with providers.

Minimum Qualifications:

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.
  • Proficient in Microsoft Office applications (Outlook, Teams, Word, Excel).

Job Level: Non-Management Non-Exempt

Workshift: Job Family: MED > Medical Ops & Support (Non-Licensed)

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Medical Management Specialist I • Miami, FL, United States

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