Medical Management Specialist

Overview

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Schedule: This position will work an 8-hour shift from 8:00 am - 5:00 pm (ET), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

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 cases and determines the appropriate area to refer or assign the 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 high school diploma or equivalent and a minimum of 1 year of experience or any combination of education and experience which would provide an equivalent background.

• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Bilingual (English-Spanish) skills are a significant plus.
• Ability to work independently and multi-task in a remote environment is a must.

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 virtually in the locations below, the salary range for this position is $24.84 to $37.25.

• Location(s): New York, NY.

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 position is based on a number of legitimate, non-discriminatory factors set by the Company, and Elevance Health is committed to equal pay for equal work regardless of gender, race, or any other protected characteristic.

• 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 may be modified in the future and actual compensation may vary based on geographic location, work experience, education, and/or skill level. No wages are earned until they are earned, vested, and determinable under applicable policies and plans.
  
  Benefits or other compensation may be modified at the Company’s discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes submitted to hiring managers are the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry.

We are creating a culture designed to advance our strategy and foster personal and professional growth. Our values and behaviors are the root of our culture and drive our outcomes and shared success. We offer a range of market-competitive total rewards, including paid holidays, Paid Time Off, incentive programs, medical/dental/vision, disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Elevance Health operates a Hybrid Workforce Strategy. Associates are typically required to work at a location…