The Medical Management Specialist I will be 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, qualifications and experiences:
Understanding of managed care or Medicaid/Medicare strongly preferred.
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.
