Medical Management Specialist I/II - PS37699

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.This position is remote and can be located anywhere in the United States. Hours of operation are 8am-5pm EST Monday-Friday. Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers. 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).

Conducts initial review of files to determine appropriate action required. Maintains and updates tracking databases.

Prepares reports and documents all actions.

Responds to requests, calls or correspondence within scope.

Provides general program information to members and providers as requested. May review and assist with cases.

Acts as liaison between medical management operations and other internal departments to support ease of administration of medical benefits.

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.

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

Qualifications This position may be filled at either MMS I or MMS II level, based on candidate’s experience and background. The level will be determined by hiring manager once the finalist has been identified.

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.

Knowledge of Facets and ACMP experience preferred but not required.

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

AnEqualOpportunityEmployer/Disability/Veteran

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.REQNUMBER: PS37699