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Medical Management Specialist I or II  Eagan, MN PS13472 in Eagan, MN at Anthem, Inc.

Date Posted: 10/13/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we’re creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.
 
Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

Medical Management Specialist I or II Eagan, MN PS13472
Work Location: Eagan, Minnesota
This is an office based position - Monday-Friday 8 a.m. - 5 p.m.

We have an immediate need for a Medical Management Specialist.  In this position, you are responsible for providing non-clinical support to medical management and/or operations areas, which may include handling 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). 
• 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. 

Level II
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. 

Level I
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.

Level II
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. For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Key Qualifications for both levels:
• Must have strong prioritization, attention to detail, and effective multi-tasking skills.
• Proficiency in MS Word, Excel, Outlook, and PowerPoint.
• Must have strong prioritization, attention to detail, and effective multi-tasking skills. 
• Excellent verbal and written communication skills.
• Behavioral Health/Physical Health experience strongly preferred.
• Experience with Sharepoint strongly preferred.
• Experience with Facets and Macess preferred. 

Please Note: This position may be filled at either the Medical Management Specialist I or Medical Management Specialist II level.  Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.