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Medical Mgmt Specialist I or II - Richmond, VA Office - PS16417 in Richmond, VA at Anthem, Inc.

Date Posted: 1/7/2019

Job Snapshot

Job Description

Your 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 benefits companies and a Fortune Top 50 Company.
 
Medical Mgmt. Specialist I or II – Richmond, VA Office
It is up to hiring manager’s discretion on which level shall the candidate be placed at based on his/her experience and background.
 
Medical Mgmt. Specialist I:
 
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, Foster Care program).
  • 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.
Medical Mgmt. Specialist 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.
 
Qualifications:
 
Medical Mgmt. Specialist 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.
  • Some Utilization Mgmt. experience preferred.
  • Some Foster Care Program experience preferred.
  • Comfortable dealing with the community.
  • Great phone skills strongly preferred.
  • Great customer service skill strongly preferred.
  • Intermediate or proficient level in Microsoft Outlook and Word required.
  • Intermediate or proficient level in Microsoft Excel strongly preferred.
  • Some Health Medical records experience preferred.
 Medical Mgmt. Specialist 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.
  • Some Utilization Mgmt. experience preferred.
  • Some Foster Care Program experience preferred.
  • Comfortable dealing with the community.
  • Great phone skills strongly preferred.
  • Great customer service skill strongly preferred.
  • Intermediate or proficient level in Microsoft Outlook and Word required.
  • Intermediate or proficient level in Microsoft Excel strongly preferred.
  • Some Health Medical records experience preferred.
 
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. An Equal Opportunity Employer/Disability/Veteran.