LOCATION: This is a remote eligible role, but you must be within 50 miles of our Richmond, VA office. Virginia residency is required.
HOURS: General business hours, Monday through Friday.
The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.
Primary duties may include, but are not limited to:
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.
Required 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 Qualifications
Understanding of managed care and/or Medicaid/Medicare is strongly preferred.
Bilingual English-Spanish skills are a huge plus.
Ability to work independently and multi-task in a remote environment is a must.
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
