Medical Management Specialist I

Location & Work Arrangement

This role enables associates to work virtually full‑time, with required in‑person training sessions for onboarding and skill development. Candidates must reside in the Richmond or Norfolk, Virginia area (Virginia residency required). Alternate locations may be considered if within a reasonable commuting distance to an office, subject to accommodation requirements.

Schedule

The position works an 8‑hour shift from 8:00 am – 5:00 pm ET, Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Responsibilities

• Gather clinical information regarding a case and determine the appropriate area to refer or assign the case (utilization management, case management, QI, Med Review).
• Provide information regarding network providers or general program information when requested.
• Assist with complex cases as needed.
• Act as liaison between Medical Management and/or Operations and internal departments.
• Maintain and update tracking databases.
• Prepare reports and document all actions.

Note: This role does not conduct utilization management review activities that require interpretation of clinical information.

Minimum Requirements

• High school diploma or equivalent.
• At least 1 year of experience, or an equivalent combination of education and experience.

Preferred Skills, Capabilities, and Experiences

• Understanding of managed care or Medicaid/Medicare (strongly preferred).
• Two years of customer service experience (strongly preferred).
• Bilingual English‑Spanish skills (a huge plus).
• Ability to work independently and multitask in a remote environment (required).
• For URAC‑accredited areas: strong oral, written, and interpersonal communication skills; problem‑solving, facilitation, and analytical skills.

Pay

Salary range for this position is $20.70 – $31.04 per hour, based on geographic location, work experience, education, and skill level.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution with match.
• Merit increases, paid holidays, and paid time off.
• Medical, dental, vision, short‑ and long‑term disability coverage.
• Life insurance.
• Wellness programs and financial education resources.

Who We Are

Elevance Health is a Fortune 25 health company dedicated to improving lives and communities while simplifying healthcare. We seek leaders at all levels who are passionate about making an impact on our members and the communities we serve.

How We Work

Our culture advances strategy and supports personal and professional growth. We operate a hybrid workforce strategy—associates are required to work on‑site at least once per week unless the role is designated primarily virtual. Vaccination against COVID‑19 and influenza is required for certain patient‑facing roles. The company emphasizes values‑driven behaviors, merit‑based rewards, and a commitment to the health of our associates and communities.