Anthem In. Case Management Jobs

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Anthem Medical Management Specialist II- Remote (Eastern or Central Time Zone)- PS27062 in Lexington, Kentucky

Medical Management Specialist II- Remote (Eastern or Central Time Zone)- PS27062

Location: Kentucky, United States

New

Requisition #: PS27062

Post Date: 6 days ago

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.

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.

The Medical Management Specialist II

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.

  • Requires a high school diploma.

  • 3 years of 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.

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and

analytical skills.

  • Strong computer skills required.

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.

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