Medical Management Specialist I
Elevance Health

Medical Management Specialist I

Preferred Location: Florida. This position will work 100% remote. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Medical Management Specialist I will be responsible for providing non-clinical support to the Medical Management and/or Operations areas.

How will you 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.

**Ideal candidate MUST reside in the state of Florida.**

**Fingerprint screening is REQUIRED.**

**Monday - Friday 8:00 am - 5:00 pm EST; Flexible start time (8 hour shift)**

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, Capabilities and Experiences:

• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.
• Candidate selected must be detailed oriented and EXTREMELY organized to be successful in this role.
• Bi-lingual is preferred; Ability to speak Creole is a PLUS!

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