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By | July 19, 2022

Job Responsibilities : Medical Management Specialist I

Salary : $52000 per year

Company : Elevance Health

Location : Remote US

Educational requirements : High School

  • Location: National +50 Miles away from nearest PulsePoint National +50 Miles away from nearest PulsePoint
  • Job Family: MED > Medical Ops & Support (Non-Licensed)
  • Type: Full time
  • Date Posted: Jul 18 2022
  • Req #: JR1821


Medical Management Specialist I

Location: Remote within 50-miles of Elevance Health Pulse Point

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).
  • 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 high school diploma.
  • 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.
  • Associates in this role are expected to have strong oral written and interpersonal communication skills problem-solving skills facilitation skills and analytical skills.
  • Previous telephonic customer service experience preferred.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem Inc. we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) +match stock purchase plan life insurance wellness programs and financial education resources to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021 is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply please visit us at 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. Applicants who require accommodation to participate in the job application process may contact for assistance.

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