Medical Mgmt Specialist I

Elevance Health • Independence, OH • 4h ago

The MyCare Ohio Plan program is to deliver high-quality, trauma informed, culturally competent, person-centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs.

Medical Management Specialist I

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. This position will be based at any Pulse Point available in Ohio, US. Ohio residency is a requirement for this position.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour from shift 8:00 am - 5:00 pm (EDT) Monday to Friday. Additional hours may be necessary based on company needs.

The Medical Management Specialist I responsible for providing non-clinical support to the Care Coordination Team.

How you will make an impact.

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.

Prepares reports and documents all actions.

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

Receive incoming member and provider calls and provide support with basic information and triage other issues to the appropriate location.

Conduct member and provider outreach to follow up on activities of care coordination.

Confirm service initiation and coordinate service delivery.

Support Care Coordinators with scheduling visits and collecting information from providers.

Help members with scheduling transportation and accessing community resources.

Facilitate exchanges of documentation between interdisciplinary teams.

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 Qualifications:

Understanding of managed care or Medicaid/Medicare strongly preferred.

Call center or other phone-based customer service experience 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Similar Jobs

Pharmacy Operations Manager

Walgreens • Lyndhurst, OH • 3h ago

Hospital & Medical

Job Description: Where state and federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations, administrative activities; Ensures efficient pharmacy workflow and a positive patie...

3h ago

Go to Apply

Nurse Manager Spry Senior Operations- SPRY Senior Brook Park

MetroHealth • Brook Park, OH • 3h ago

Hospital & Medical

Location: SPRY Brookpark Biweekly Hours: 80.00 Shift: Monday-Friday- 8a-4:30p The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-bei...

3h ago

Go to Apply

Medical Assistant - Pediatrics

Cleveland Clinic • Cleveland, OH • 4h ago

Hospital & Medical

Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one...

4h ago

Go to Apply

Acute Inpatient Registered Nurse - RN

Fresenius Medical Care North America • Cleveland, OH • 8h ago

Hospital & Medical

PURPOSE AND SCOPE: The professional registered nurse Inpatient Services RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP). This position is accountable and responsible for the provision a...

8h ago

Go to Apply

Administrative Assistant II - Pulmonary Medicine

Cleveland Clinic • Cleveland, OH • 14h ago

Hospital & Medical

Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family. Here, you will work alongside a passionate and dedicated tea...

14h ago

Go to Apply

Registered Radiology Technologist

Cleveland Clinic • Solon, OH • 14h ago

Hospital & Medical

14h ago

Go to Apply

Registered Radiology Technologist

Cleveland Clinic • Strongsville, OH • 15h ago

Hospital & Medical

15h ago

Go to Apply

Registered Radiology Technologist

Cleveland Clinic • Twinsburg, OH • 15h ago

Hospital & Medical

15h ago

Go to Apply

Nursing Professional Development Specialist - Central Nursing Orientation Facilitator

Cleveland Clinic • Beachwood, OH • 18h ago

Hospital & Medical

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build...

18h ago

Go to Apply

Diagnostic Medical Sonographer

Cleveland Clinic • Euclid, OH • 1d ago

Hospital & Medical

This position is eligible for a sign-on bonus of up to $5,000 Join Cleveland Clinic's Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are famil...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.