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　　Medical Management Specialist I (Florida)

　　Job Family: Medical and Clinical

　　Type: Full time

　　Date Posted:Jan 23, 2024

　　Anticipated End Date:Jan 30, 2024

　　Reference: JR102510

　　Location:

　　FL, MIAMI

　　Florida, Tallahassee

　　FL, ALTAMONTE SPRINGS

　　Florida, Tampa

　　Florida, Jacksonville

　　Description

　　Medical Management Specialist I

　　Location: Candidate must be located within 50 miles of an Elevance Health PulsePoint office in the state of Florida

　　Schedule: Monday-Friday 8am-5pm

　　The Medical Management Specialist I is 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.

　　Minimum Requirements:

　　Requires a high school diploma and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background.Preferred Skills, Capabilities and Experiences:

　　Bilingual in English/Spanish strongly preferred.

　　Proficiency in Excel preferred.

　　Understanding of managed care or Medicaid/Medicare strongly preferred.

　　For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

　　Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

　　Who We Are

　　Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

　　How We Work

　　At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

　　We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

　　Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

　　The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

　　Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

　　EEO is the Law

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　　Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

　　EEO Policy Statement

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　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])