Medical Management Specialist I

Elevance Health; Miami (FL); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading health company is seeking a Medical Management Specialist I to provide non-clinical support in Miami. This role offers flexibility to work virtually with occasional in-person training. The ideal candidate will possess a high school diploma and at least one year of experience. Strong communication skills are essential, and bilingual candidates are preferred. The position includes competitive rewards and the chance to impact community health.

Benefits

Merit increases

Paid holidays

401(k) + match

Wellness programs

Qualifications

• Minimum 1 year of experience in a relevant field or a combination of education and experience.
• Bilingual in English/Spanish is preferred.

Responsibilities

• Gather clinical information regarding cases.
• Provide information regarding network providers.
• Maintain tracking databases.
• Prepare reports on actions taken.

Skills

Oral communication

Written communication

Interpersonal skills

Problem-solving skills

Analytical skills

Education

H.S. diploma or equivalent

Job description

Overview

Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. This position will be based in Miami, 11430 NW 20th Street, 33172.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: 8-hour shifts, 8:00 am – 5:00 pm (EST), Monday to Friday. Additional hours may be necessary based on company needs.

How you will make an impact

Primary duties may include, but are not limited to:

• 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.
• Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

Minimum 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 Qualifications

• Understanding of managed care or Medicaid/Medicare strongly preferred.
• Fully bilingual (English/Spanish) strongly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Additional Information

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy and support personal and professional growth. Our values and behaviors are the root of our culture and guide how we achieve our strategy, power our business outcomes and drive our shared success.

We offer 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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer may be rescinded unless you provide an acceptable explanation. Elevance Health will follow all relevant federal, state, and local laws.

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. Applicants who require accommodation to participate in the job application process may contact [e-mail] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.