Medical Mgmt Specialist I
Elevance Health

Topeka, Kansas

Posted in Health and Safety


Job Info


Location:

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.



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