/ Your Talent. Our Vision. / At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive 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.
Location:This position must be based out of either our San Jose, CA office (60 S. Market Street) or our El Paso, TX office (7430 Remcon Circle.)
TheMedical Management Specialistl is 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.
High school diploma; 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.
Bilingual in either English/Korean OR English/Chinese (Cantonese/Mandarin) OR English/Vietnamese OR English/Spanish (Applicants required to take the Berlitz language assessment.)
/ Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /
Title: Medical Management Specialist I - San Jose, CA or El Paso, TX - 123209
Location: CA-San Jose
Other Locations: TX-El Paso
Requisition ID: 123209
A little about us:
We have shared values and a similar mission.