Job Details

ID #3305336
State Illinois
City Deerfield
Full-time
Salary USD TBD TBD
Source Anthem, Inc.
Showed 2020-01-29
Date 2020-01-30
Deadline 2020-03-30
Category Et cetera
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Medical Management Specialist I or II (Remote - 1 hour from Anthem office) (PS32547)

Illinois, Deerfield 00000 Deerfield USA

Vacancy expired!

Medical Management Specialist I or II (Remote - 1 hour from Anthem office) (PS32547)Location: United StatesNewRequisition #: PS32547Your Talent. Our Vision. At Anthem, Inc. , it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.Medical Management Specialist I or IIPlease note: This position will be filled at either the I, II, or III level. The hiring manager will determine the appropriate level based upon the selected applicant's experience and skill set relative to the qualifications listed for this position.The hours of the role are 8:30 to 5:00pm in your time zone. Monthly rotation to work 12:30pm to 9:30pm.LEVEL IThis role is responsible for providing non-clinical support to the Medical Management and/or Operations areas.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.

LEVEL IIThis role is responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.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).

Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.

Prepares reports and documents all actions.

Responds to requests, calls or correspondence within scope.

Provides general program information to members and providers as requested.

May review and assist with cases.

Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.

May assist with case referral process.

May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

For California Children Services: May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition. Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals. Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

LEVEL I

Requires a high school diploma

1 year of experience with an understanding of managed care or Medicaid/Medicare

Or any combination of education and experience, which would provide an equivalent background.

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

LEVEL II

Requires a high school diploma

3 years of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts

Or any combination of education and experience, which would provide an equivalent background.

For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

AnEqualOpportunityEmployer/Disability/Veteran

Vacancy expired!

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