Medical Mgmt Specialist

Medical Management Specialist I

Location: Washington, DC – the role requires in‑office presence 4 days per week. Alternate locations may be considered; candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.

Schedule: Monday – Friday, 8:00 AM – 5:00 PM or 8:30 AM – 5:30 PM EST

• Gather clinical information regarding cases and determine appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
• Provide information regarding network providers or general program information when requested.
• May assist with complex cases.
• May act as liaison between Medical Management/Operations and internal departments.
• Maintain and update tracking databases.
• Prepare reports and document all actions.

• High school diploma or equivalent and at least 1 year of experience (or equivalent combination of education and experience).

• Understanding of managed care or Medicaid/Medicare; strongly preferred.

Hourly range: $23.46 / hr – $35.19 / hr (may be adjusted based on location, experience, education, and other factors).

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase option and 401(k) contribution (subject to eligibility). Benefits are subject to eligibility requirements.

Elevance Health is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.