Medical Mgmt Specialist I - North Carolina
Core
Provides non-clinical support to Medical Management and Operations by gathering clinical information, determining case referral areas, and maintaining tracking databases.
Role type
Entry-level Medical Management Specialist (Non-Licensed)
Builds
Case management workflows and operational support for healthcare members
Domain
Healthcare / Insurance / Utilization Management
Deliverable
Dashboards & analysis
Required skills
Case triage, database maintenance, report preparation, provider network information lookup, liaison communication
Preferred skills
Managed care knowledge, Medicaid/Medicare understanding
Responsibilities
Gather clinical information to determine case referral areas, provide network provider information, assist with complex cases, act as liaison between departments, maintain tracking databases, prepare reports
Seniority
Entry-level, Non-Management Non-Exempt
