Medical Management Specialist I

Medical Management Specialist I

Location: While remote, candidate must reside in Virginia and be ideally located within 50 miles of a PulsePoint.

The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

How you will make an impact:

• 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.

Minimum Requirements:

• Requires a high school diploma and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Understanding of managed care or Medicaid/Medicare strongly preferred.

• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.