Medical Management Specialist II (Medicare)

Medical Management Specialist II (Medicare)

16 Dec 2024
California, Applevalley, 92307 Applevalley USA

Medical Management Specialist II (Medicare)

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.Medical Management Specialist ll – PS42851Work Location: This position will allow you to work from home. Qualified applicants must reside within a 1 hour commute to an Anthem office.Work Hours (Eastern or Central Standard Time): 8 hour shift between the hours of 8am – 5:30pm, Monday – Friday.The Medical Management Specialist ll is responsible for providing non-clinical support to the Medical Management Operations areas and handles more complex file reviews and inquiries from members, but providers primarily. 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.

May act as liaison between Medical Management and/or Operations and internal departments.

Maintains and updates tracking databases.

Prepares reports and documents all actions.

Answers and handles incoming calls for UMCM department.

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

Conducts initial review of files to determine appropriate action required.

Provides general program information to members and providers as requested.

May assist with case referral process.

May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

Qualifications Requires:Requires a high school diploma; 3 years of administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts; or any combination of education and experience, which would provide an equivalent background.

Prior Medical Management experience required.

Experience working with providers telephonically a plus.

Experience preparing reports strongly preferred.

MS Excel required.

ACMS / ACMP preferred.

Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.REQNUMBER: PS42851

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