Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Medical Management Specialist II in Houston, Texas


SHIFT: Day Job

SCHEDULE: Full-time

NOTE: Associates that are assigned to work in an Anthem business/office will need to be vaccinated in order to grant access to the building


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.


Minimum Requirements:

  • Requires a high school diploma and a minimum of 3 years administrative and customer service experience with knowledge of managed care or Medicaid/Medicare concepts; or any combination of education and experience which would provide an equivalent background.

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Preferred Qualifications:

  • Bilingual in Spanish preferred

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS55790