Medical Management Specialist I

Medical Management Specialist IMedical Management Specialist IVirtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.How you will make an impact:Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review), including triaging information from the shared mailbox.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.Scheduling of Peer-to-Peers to facilitate Medical Director discussions with providers.Minimum Qualifications:Requires a H.S. diploma or equivalent 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:Understanding of managed care or Medicaid/Medicare strongly preferred.Proficient in Microsoft Office applications (Outlook, Teams, Word, Excel).Job Level: Non-Management Non-ExemptWorkshift: Job Family: MED > Medical Ops & Support (Non-Licensed)