Medical Management Specialist I
Elevance Health

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.
  

• 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.
  

• 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.