Medical Management Specialist I
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About The Position
The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas. This position is remote, but candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The role requires part-time availability on weekends only (Saturday & Sunday) with a 10-hour shift. Training will be conducted full-time for 3 weeks, Monday to Friday, after which the schedule will shift to weekends. Primary duties may include, but are not limited to: gathering clinical information regarding cases and determining the appropriate area to refer or assign cases (utilization management, case management, QI, Med Review), providing information regarding network providers or general program information when requested, assisting with complex cases, acting as a liaison between Medical Management and/or Operations and internal departments, maintaining and updating tracking databases, and preparing reports while documenting all actions. Responsibilities exclude conducting any utilization management review activities that require interpretation of clinical information.
