[Hiring] Medical Management Specialist I @Elevance Health

Role Description

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.
• Regularly interacts with providers regarding authorization related inquiries.
• 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.

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.
• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Previous experience in healthcare industry and customer service is preferred.
• One year of experience working with authorizations is preferred.
• Previous experience working with LTSS members or Medicaid is strongly preferred.
• Strong oral, written and interpersonal communication skills.
• Problem-solving skills, facilitation skills, and analytical skills.

Requirements

• Location: 4800 Westown Pkwy, Ste200, W Des Moines, Iowa.
• Iowa residency is required.
• This position will work an 8-hour shift from 8:00 am - 5:00 pm (CDT), Monday through Friday.
• Additional hours, including weekends or holidays, may be required based on operational needs.

Benefits

• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs.
• Medical, dental, vision benefits.
• Short and long term disability benefits.
• 401(k) + match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.