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Medical Management Specialist ...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Miami, FL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3779

Medical Management Specialist I - Miami, FL - PS3779

About the Job

Description
Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it's a powerful combination and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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.

Medical Management Specialist I - Miami, FL - PS3779

This position is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

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.
  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Qualifications
  • Requires a high school diploma
  • 1 year of experience with an understanding of managed care or Medicaid/Medicare; or any combination of education and experience, which would provide an equivalent background.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
 

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