Anthem, Inc. Medical Management Specialist II in La Mirada, California
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.
A Medical Management Specialist I or Medical Management Specialist II is responsible for providing non-clinical support to medical management operations, which includes handling more complex file reviews and inquiries from members and providers.
This position can be filled as a Medical Management Specialist I or Medical Management Specialist II. The hiring manager will determine the level, based on the candidate’s experience and background.
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.
- Requires a high school diploma or GED equivalent and a minimum of 1 year experience with an understanding of managed care or Medicaid/Medicare; or any combination of education and experience which would provide an equivalent background.
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 careers.antheminc.com. 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.