Medical Management Specialist I

The Elevance Health Companies, Inc.; Waukesha (WI); Hybrid; USD 50,000 - 65,000; Full time

Benefits offered by this job

Medical

Dental

401(k) + match

Paid Time Off

Job summary

Elevance Health seeks a Medical Management Specialist I to provide non-clinical support to Medical Management and Operations. You will gather clinical information, refer cases to the appropriate area, and interact with providers regarding authorization inquiries, while maintaining tracking databases and preparing reports.

The role emphasizes collaboration across teams, with a focus on key processes in utilization management and case referrals, and requires adaptability to occasional in-person

Qualifications

• Requires a HS diploma or equivalent and at least 1 year of experience.
• Relevant experience in healthcare or managed care is preferred.
• Experience with authorizations is desirable.

Responsibilities

• Gather clinical information and refer cases to appropriate area.
• Provide information about providers and program details.
• Interact with providers regarding authorization inquiries.
• May assist with complex cases and act as liaison between Medical Management and Operations.
• Maintain tracking databases and prepare reports.

Skills

Healthcare knowledge

Customer service

Communication skills

Team liaison

Education

High school diploma or equivalent

Job description

Position Title

Medical Management Specialist I

Anticipated End Date

2026-11-07

Location

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule

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

Job Description and Responsibilities

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 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.
• Regularly interacts with providers regarding authorization related inquiries.
• 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.

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.
• Previous experience in healthcare industry and customer service is a plus.
• An associate degree in Arts or Science is preferred.
• One year of experience working with authorizations is desired.
• Previous experience working with LTSS members or Medicaid is strongly preferred.

Professional competencies for URAC accredited areas

Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level

Non-Management

Workshift

Job Family: MED > Medical Ops & Support (Non-Licensed)

Who We Are

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, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

Hybrid Workforce Strategy

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Vaccination Notice

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer, and 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.

Accessibility Accommodation Request

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Background Check Information

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Florida Law Screening

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Additional Information

Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

Note

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

Join our Talent Community

Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

Equal Employment Opportunity Employer Disclaimer

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.