Medical Management Specialist – Non-Clinical

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

📋 Description

• Carry out case management functions, which include telephonic member screening, care planning, implementing care plans, coordinating services, monitoring and follow-up, reassessment, conducting case conferences, crisis intervention, and case closure.

• Offer non-clinical assistance to the medical management or operations sector.

• Review case files and collect clinical information to ascertain the appropriate department or area for case allocation.

• Handle incoming member case management calls and assess member needs through screening.

• Provide community resources and other support options to members.

• Make suitable referrals to clinical case managers for members.

• Return voicemail messages received on the case management phone line.

• Oversee and manage the inbound phone queue for case management.

• Supply information regarding in-network providers or general program details.

• Assist with complex cases while serving as a liaison between Case Management and various internal departments.

• Maintain and refresh tracking databases as needed.

• Prepare reports and document all actions taken.

• Exclude activities related to utilization management reviews and other clinical roles that require interpretation of clinical information.

⛳️ Requirements

• High School Diploma or equivalent is mandatory.

• At least 1 year of relevant experience in managed care, Medicaid/Medicare, or a similar field is preferred.

• Excellent organizational and communication abilities.

• Proficient computer skills are essential.

• Must live within 50 miles of Indianapolis, Indiana.

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

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and career advancement.

• Supportive and dynamic work environment.