Medical Mgmt Specialist I

Elevance Health; Tampa (FL); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Benefits package

Job summary

Elevance Health is seeking a non-clinical support professional to assist the Medical Management and Operations teams. The role involves gathering clinical information, routing cases, and providing program information to internal stakeholders.

You will maintain tracking databases, prepare reports, and support liaison activities between departments. A HS diploma and at least 1 year of related experience are required, with preferred familiarity in managed care.

Qualifications

• H.S. diploma or equivalent; minimum 1 year of experience or an equivalent combination of education and experience.
• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Provide non-clinical support to Medical Management and/or Operations areas.
• Gather clinical information regarding cases and determine appropriate area to refer or assign (utilization management, case management, QI, Med Review).
• Provide information regarding network providers or general program information when requested.
• Assist with complex cases.
• Act as liaison between Medical Management and/or Operations and internal departments.
• Maintain and update tracking databases.
• Prepare reports and document all actions.
• Responsibilities exclude conducting any utilization management review activities requiring interpretation of clinical information.

Skills

Oral communication

Written communication

Interpersonal skills

Problem solving

Facilitation

Analytical skills

Education

H.S. diploma

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

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.

Primary duties may include, but are not limited to:

Responsible for providing non-clinical support to the Medical Management and/or Operations areas.

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.

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.

Understanding of managed care or Medicaid/Medicare strongly preferred. For URAC accredited areas, the following professional competencies apply:

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

Job Type: Contract

Candidates must reside within 50 miles or 1-hour commute each way of a relevant Florida Elevance Health location.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

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.