Clinical Support Specialist: Medical Management & Admin

Remote Jobs; Harrisburg (Dauphin County); On-site; USD 42,000 - 54,000; Full time

Job summary

Capital Blue Cross is seeking a Clinical Support Specialist to provide administrative support to the clinical team, handling medical management records, authorizations, and referral management. The role emphasizes accuracy, regulatory compliance, and effective communication with members and providers.

You will support UM, CM, and PHM processes, participate in reporting, and help maintain high standards of service within a collaborative team environment. Experience in medical field preferred.

Qualifications

• Minimum 2 years' experience in the medical field or 2 years in a managed care clinical department.
• Proficiency with Microsoft Office and medical terminology.
• Knowledge of health insurance industry and plan products (e.g., PPO, HMO).
• Familiarity with NCQA and CMS regulatory standards.

Responsibilities

• Support clinical processes by building medical management records and authorizations.
• Conduct outreach to members/providers to communicate UM/CM status.
• Assist with administrative functions at health events such as health fairs.
• Document interventions in the member's medical management record per policies.
• Support department compliance and performance via report monitoring and distribution.

Skills

Strong organizational and time mgmt

Attention to detail

Policy and procedure compliance

Written and oral communication

Education

High School Diploma

Continued higher education

Job description

Capital Blue Cross is seeking a Clinical Support Specialist to provide administrative support to the clinical team, handling medical management records, authorizations, and referral management. The role emphasizes accuracy, regulatory compliance, and effective communication with members and providers.

You will support UM, CM, and PHM processes, participate in reporting, and help maintain high standards of service within a collaborative team environment. Experience in medical field preferred.