Medical Mgmt Specialist I at Elevance Health in Overland Park, Kansas

Job Description:

Location: Candidate must live within 50 miles of our Kansas PulsePoint offices.


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.

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


• 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.