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.
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
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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
