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Medical Mgmt Specialist I-II - Remote - PS5665

Medical Mgmt Specialist I-II - Remote - PS5665
New
Location: United States
Field: Medical
Requisition #: PS5665
Post Date: 8 hours ago
Your Talent. Our Vision. at Anthem , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it?s a powerful combination. It?s 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.
Medical Management Specialist I
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 benefits companies and a Fortune Top 50 Company.
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. Inputs and approves authorizations for services.
+ May act as liaison between Medical Management and/or Operations and internal departments.
+ May update tracking databases.
+ May prepare reports and documents all actions.
+ Responsibilitiesexcludeconducting any utilization management review activities which require interpretation of clinical information.
+ Will take phone calls on a customer service queue daily regarding authorizations and program inquiries.

Medical Management Specialist II
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.
+ High School diploma or GED required;
+ Minimum of 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.
+ Must be able to sit and communicate by telephone for extended periods of time.
+ Able to work in a fast paced environment with ability to prioritize work and meet deadlines.
+ Multitasking, active listening, and attention to detail required.
+ Knowledge of Microsoft Word, Excel, and Outlook required.
+ Experience working in Mental Health or Physical Health Field a plus.
+ Customer service background in the healthcare industry preferred.
+ Knowledge of medical terminology preferred.
+ Data Entry experience preferred
+ Call Center experience preferred.
+ CNA/CMA preferred.
This position is remote, but must be within 1 hour from an Anthem office.
You must be flexible, as the hours can range from 8:00AM to 8:00PM Eastern time.
_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_


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