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Medical Management Specialist I- Remote- PS31648Location: Tennessee, United StatesNewRequisition #: PS31648Your 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/II – Nationwide (Remote)We may hire this position at Level I or Level II, which is to be determined by the hiring manager.Location: This is a remote position, but you MUST live within 1 hour of an Anthem office location to be considered.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.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Qualifications:
Requires a high school diploma or equivalent;
1-3 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.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
You must live within 1 hour of an Anthem office location to be considered.
FACETS experience required
ACMP and MACESS experience preferred
MS Office – Excel, Word, Outlook
Time-management, multi-tasking required
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran
Vacancy expired!