JOB PURPOSE:

Under the direction of the Medical Management Nurse Manager, the Medical Management Specialist is responsible for facilitating member and provider requests within the Medical Management Department.  The Specialist will support the department’s business operations in developing and implementing care management services which support the Medical Management department. Responsibilities include calling members to complete health risk assessments and inputting authorization data gathered from providers in system. The Specialist will maintain the regulatory standards and department guidelines for timeliness and accuracy for telephonic contacts, correspondence and service authorizations. The position will serve as a liaison between CCM and its members and providers.

Job Qualifications:

Education:  

- College Degree or Associate degree is required.  

Experience: 

- Experience in a call center or customer service role within the health care industry is preferred.

- Requires excellent verbal and communications skills

- Requires excellent organizational skills

- Knowledge of Medicare / Medicaid principles is preferred

- Requires good PC skills and ability to manage applicable software

- Requires good interpersonal skills and the ability to work with all levels of employees

- Working knowledge of the principles of utilization management is preferred 

- Ability to speak in multiple languages (ex: Spanish / Chinese / Russian) is beneficial