Medical Mgmt Specialist I-2
Core
Provides non-clinical support to Medical Management and Operations areas by gathering clinical information, determining referral areas, and maintaining tracking databases.
Role type
Medical Management Specialist (Non-Licensed)
Builds
Supports utilization management, case management, and quality improvement processes for health plan members.
Domain
Health Insurance / Managed Care
Deliverable
Dashboards & analysis
Required skills
Data entry, report preparation, liaison communication, case tracking
Preferred skills
Managed care knowledge, Medicaid/Medicare understanding, Korean language proficiency
Technologies
Tracking databases
Responsibilities
Gather clinical information to determine referral areas, provide network provider information, assist with complex cases, maintain tracking databases, prepare reports
Seniority
Entry-level, non-management
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