Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Simply Healthcare , a proud member of the Anthem, Inc . family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs; 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.
Responsibilities :
The Medical Management Specialist 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.
Qualifications
Minimum Requirements:
• A high school diploma
• A minimum of 1 year experience; or any combination of education and experience which would provide an equivalent background.
Preferred Qualifications:
• An understanding of managed care or Medicaid/Medicare preferred.
• For URAC accredited areas, the following professional competencies apply: Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.
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.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.