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.
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.
- May act as liaison between Medical Management and/or Operations and internal departments.
- 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.
- Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Benefits
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
Schedule
Monday through Friday, 8AM-5PM EST/PST.
Pay
The salary range for this specific position is $20.70 to $29.75.
Location(s)
- California
- Nevada
- Virginia
Company Information
- Carelon is a healthcare services organization that puts people at the center, connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
- 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.
Equal Opportunity Employer
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.