Medical Management Specialist II
Hanover, MD Hanover, MD Full-time Full-time From $24 an hour From $24 an hour 21 hours ago 21 hours ago 21 hours ago MUST LIVE WITHIN DRIVEABLE DISTANCE OF HANOVER, MARYLAND ( May have to go into Hanover office up to 3 times a month) Hours:
8:
30 A to 5:
30 P EST Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.
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).
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.
Provides general program information to members and providers as requested.
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.
For California Children Services:
May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition.
Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Requirements:
High school diploma Minimum of 3 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background.
Preferred:
Knowledge of managed care or Medicaid/Medicare concepts Previous call center (phone work) Ability to multi-task Medical knowledge For URAC accredited areas, the following professional competencies apply:
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Job Type:
Full-time Pay:
From $24.
00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Retirement plan Tuition reimbursement Schedule:
Monday to Friday Weekend availability Ability to commute/relocate:
Hanover, MD 21076:
Reliably commute or planning to relocate before starting work (Required)
Experience:
Customer Service:
3 years (Required) Medicaid/Medicare:
3 years (Preferred) Call Center:
3 years (Preferred) Work Location:
Hybrid remote in Hanover, MD 21076.
Estimated Salary: $20 to $28 per hour based on qualifications.
8:
30 A to 5:
30 P EST Responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.
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).
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.
Provides general program information to members and providers as requested.
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.
For California Children Services:
May request medical records from providers, may complete and submit CCS referral to local CCS program on same date of identification of potential CCS eligible condition.
Tracks referral according to specified timelines and notifies providers and families of CCS eligibility determinations and referrals, BCC authorizations and/or deferrals.
Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
Requirements:
High school diploma Minimum of 3 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background.
Preferred:
Knowledge of managed care or Medicaid/Medicare concepts Previous call center (phone work) Ability to multi-task Medical knowledge For URAC accredited areas, the following professional competencies apply:
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Job Type:
Full-time Pay:
From $24.
00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Retirement plan Tuition reimbursement Schedule:
Monday to Friday Weekend availability Ability to commute/relocate:
Hanover, MD 21076:
Reliably commute or planning to relocate before starting work (Required)
Experience:
Customer Service:
3 years (Required) Medicaid/Medicare:
3 years (Preferred) Call Center:
3 years (Preferred) Work Location:
Hybrid remote in Hanover, MD 21076.
Estimated Salary: $20 to $28 per hour based on qualifications.
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