Anthem Medical Management Specialist I-II (Remote) - Indianapolis, IN - PS13923 in Indianapolis, Indiana

Medical Management Specialist I-II (Remote) - Indianapolis, IN - PS13923

Location: Indianapolis, Indiana, United States

Field: Medical

Requisition #: PS13923

Post Date: Nov 02, 2018

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.

The Medical Management Specialist l is responsible for providing non-clinical support to the Medical Management and/or Operations.

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 review and assist with complex cases.

  • May act as liaison between Medical Management and/or Operations and internal departments.

  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

The Medical Management Specialist ll is also responsible for providing non-clinical support to medical management operations, but also includes handling more complex file reviews and inquiries from members and providers.

In addition to the duties of the Medical Management Specialist ll, the primary duties may include, but are not limited to:

  • 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.

  • 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.

Note: This position may be filled as a Level l or ll depending on qualifications.

The Medical Management Specialist l requires:

  • High school diploma; 1 year of experience with an understanding of managed care or Medicaid ; or any combination of education and experience, which would provide an equivalent background.

  • 1 year managed care industry experience required.

  • Experience Medical management applications preferred.

  • Familiar with Outlook, Word, Excel.

  • Prior utilization management and/or case management support experience helpful.

  • Medicaid or Medicare experience preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.