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Medical Management Specialist I - Hanover, MD - PS20670 at Anthem, Inc.

Posted in Management 27 days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Hanover, Maryland





Job Description:

Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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.  

Medical Management Specialist I 

Location: 7550 Teague Road, Suite 500, Hanover, MD 21076
Work Hours: Monday through Friday, 8:30 am-5:30 pm EST

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:


  • Requires a high school diploma or equivalent; 

  • 1 year of experience with an understanding of managed care or Medicaid/Medicare; 

  • Or, any combination of education and experience, which would provide an equivalent background. 

  • Skills Required - strong oral, written and interpersonal communication / problem-solving / facilitation, analytical, planning / time-management / multi-tasking

  • Ability to toggle between multiple systems and phone simultaneously required

  • MS Office experience required - Word, Excel, Outlook

  • Previous experience with FACETS, MACESS 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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.