Medical Management Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Deliver non-clinical assistance to medical management operations calls.

• Address intricate file reviews and inquiries from both members and providers.

• Collect clinical details and identify the suitable area for case referral or assignment.

• Perform initial file evaluations to ascertain necessary actions.

• Manage and refresh tracking databases.

• Generate reports and document all activities.

• Attend to requests, calls, and correspondence within the designated scope.

• Offer general program information to both members and providers.

• Review and provide support for cases.

• Partner with external community-based organizations to facilitate and coordinate care under the guidance of an RN Case Manager.

• Serve as a liaison between medical management operations and internal departments.

• Mentor and provide work direction to junior associates.

⛳️ Requirements

• High school diploma required.

• At least 5 years of administrative and customer service experience, or a combination of education and experience providing an equivalent background.

• Strong knowledge of managed care or Medicaid/Medicare concepts is highly preferred.

• Excellent customer service and call center skills.

• Availability to work Monday through Friday, from 8 am to 5 pm.

• Capability to complete necessary training.

🏝️ Benefits

• Medical, dental, and vision insurance available.

• Supplemental insurance options provided.

• 80 hours of paid time off after 90 days of employment.

• 10 paid holidays throughout the year.

• Opportunity to work from home.