Medical Management Specialist
Job Description
At Elevance Health, we are looking for a Medical Management Specialist who will be a dynamic addition to our team. If you are an experienced professional with a passion for healthcare and a commitment to providing outstanding care for our members, then we want to hear from you! The ideal candidate for this role should possess a Bachelor’s degree in health services administration, health informatics, or a related field, and at least 5 years of experience in the healthcare industry. You should have a solid understanding of medical management concepts, including utilization management, case management, and quality improvement. Additionally, you should have strong project management skills and experience in data analysis. Ideal candidates should have excellent problem-solving and communication skills, be highly organized, and have the ability to collaborate with team members. If you are ready to make a difference in the lives of our members and join a team of dedicated healthcare professionals, please apply today!
Responsibilities:
Manage utilization, case, and quality improvement programs for members.
Analyze data to identify trends and recommend solutions to improve healthcare services.
Develop and implement strategies to improve the quality and cost-effectiveness of healthcare services.
Monitor medical management processes to ensure compliance with regulations and standards.
Prepare reports and present findings to management.
Collaborate with team members to develop best practices and policies.
Educate members on medical management processes and procedures.
Stay up to date on new developments in the healthcare industry.
Handle incoming calls and inquiries from members.
Perform other duties as assigned.
Elevance Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.