Medical Management Specialist

Anticipated End Date:

Position Title: Medical Management Specialist I

Job Description:

Medical Management Specialist I

Location:

Virtual - This role enables associates to work virtually full‑time, except for 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.

Work Shift:

Monday – Friday, 8:00 am to 4:30 pm (PST)

The Medical Management Specialist I is responsible for providing non‑clinical support to the Medical Management and/or Operations areas.

• 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.
• Outreaches to providers and members.

• Requires a H.S. diploma or equivalent and a minimum of 1 year of experience in customer service or in healthcare or any combination of education and experience which would provide an equivalent background.

• Experience working in the behavioral health field.
• Understanding of managed care strongly preferred.
• Strong customer service and communication skills.
• Understanding of ACMP preferred but not necessary.

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.

For candidates working in person or virtually in the below locations, the pay
* range for this specific position is $21.40/hr. to $36.70/hr.

Location(s):
California, Colorado, Nevada and Washington.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non‑discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level: Non-Management Non‑Exempt

Workshift: 1st Shift (United States of America)

Job Family: MED >
Medical Ops & Support (Non‑Licensed)

Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those…