Medical Management Specialist I
About the role
The Medical Management Specialist I role provides non-clinical support to the Medical Management and/or Operations areas. This position works virtually full-time with the option for occasional in-person training sessions.
Responsibilities
- 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.
- Maintains and updates tracking databases.
- Prepares reports and documents all actions.
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
- Fully Bilingual (English & Spanish/Creole). Must be able to write, read and speak both languages in a proficiency level preferred.
- Understanding of managed care or Medicaid/Medicare strongly preferred.
- Previous experience in healthcare industry and customer service is a plus.
- Previous experience working with LTSS members or Medicaid is strongly preferred.
Benefits
Simply Healthcare Plans, Inc. offers a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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 and financial education resources, to name a few.
Pay
Simply Healthcare Plans, Inc. offers competitive compensation and benefits packages.
Schedule
This position will work an 8-hour shift from 8:00 am - 5:00 pm (EST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.