Remote Medical Management Coordinator

Elevance Health, Inc.; Waukesha (WI); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Elevance Health is seeking a Medical Management Specialist I to provide non-clinical support within the Medical Management and/or Operations areas. The role involves gathering clinical information, referring cases, and assisting with authorizations inquiries, while maintaining tracking databases and preparing reports.

The position requires a high school diploma and at least one year of experience (or an equivalent mix of education/experience).

Qualifications

• Requires a high school diploma or equivalent and a minimum of 1 year experience or an equivalent combination of education and experience.
• Understanding of managed care, Medicaid/Medicare preferred.
• Healthcare industry and customer service experience a plus.
• One year experience with authorizations is desired.
• LTSS or Medicaid experience is strongly preferred.

Responsibilities

• Gathers clinical information regarding cases and determines the appropriate area to refer or assign (utilization management, case management, QI, Med Review).
• Provides information regarding network providers or 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 Operations and internal departments.
• Maintains and updates tracking databases.
• Prepares reports and documents all actions.

Skills

Healthcare experience

Strong communication

Customer service

Authorizations knowledge

Education

High School Diploma

Associate degree preferred

Job description

Elevance Health is seeking a Medical Management Specialist I to provide non-clinical support within the Medical Management and/or Operations areas. The role involves gathering clinical information, referring cases, and assisting with authorizations inquiries, while maintaining tracking databases and preparing reports.

The position requires a high school diploma and at least one year of experience (or an equivalent mix of education/experience).