Medical Management Specialist I

About the role

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.
• 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

• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Previous experience in healthcare industry and customer service is preferred.
• One year of experience working with authorizations is preferred.
• Previous experience working with LTSS members or Medicaid is strongly preferred.

Benefits

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $19.66 to $31.04.

Location(s): Norfolk-VA, Richmond-VA & Roanoke-VA.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. 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.

Schedule

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