Medical Management Specialist I at Elevance Health in Tampa, Florida

Job Description:

Medical Management Specialist I




Preferred Location: Florida. This position will work 100% remote. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.


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



How will you 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.

**Ideal candidate MUST reside in the state of Florida.**


**Fingerprint screening is REQUIRED.**


**Monday - Friday 8:00 am - 5:00 pm EST**



Minimum Requirements:

• 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.

Preferred Skills, Capabilities and Experiences:

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


• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.


• Bi-lingual speaking is a PLUS.

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