Medical Management Specialist I
Core
Provides non-clinical support to Medical Management and Operations by gathering clinical information, determining case referral areas, interacting with providers on authorizations, and maintaining tracking databases.
Role type
Medical Management Specialist I (Non-Management Non-Exempt)
Builds
Case management workflows, utilization management assignments, and operational reports for healthcare members.
Domain
Healthcare / Managed Care / Medicaid/Medicare
Deliverable
dashboards & analysis
Required skills
Case information gathering, Provider interaction, Authorization inquiries, Database maintenance, Report preparation, Liaison communication
Preferred skills
Managed care knowledge, Medicaid/Medicare experience, Healthcare industry background, Customer service, LTSS member experience
Technologies
Tracking databases
Responsibilities
Gathers clinical information to determine case referral areas, Provides network provider and program information, Interacts with providers regarding authorization inquiries, Assists with complex cases, Acts as liaison between Medical Management and internal departments, Maintains and updates tracking databases
Seniority
Entry-level, Individual Contributor