Medical Management Specialist I at Elevance Health

Norfolk, Virginia, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

H.S. diploma or equivalent
Minimum of 1 year experience or any combination of education and experience which would provide an equivalent background
Located within commuting distance of one of the following Pulsepoints: Norfolk-VA, Richmond-VA, Roanoke-VA, Indianapolis-IN, Atlanta-GA, Tampa-FL, Lake Mary-FL or Miami-FL (unless accommodation granted as required by law)
Availability for 8-hour shift from 8:00 am - 5:00 pm, Monday through Friday, with possible additional hours including weekends or holidays based on operational needs

Responsibilities

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
Regularly interacts with providers regarding authorization related inquiries
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
Provides non-clinical support to the Medical Management and/or Operations areas

Skills

Utilization Management

Case Management

Provider Network

Authorization Inquiries

Tracking Databases

Report Preparation

Data Entry

Liaison

Clinical Information Gathering

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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