Medical Management Specialist

At Elevance Health, we are looking for a Medical Management Specialist who will be a dynamic addition to our team. If you are an experienced professional with a passion for healthcare and a commitment to providing outstanding care for our members, then we want to hear from you! The ideal candidate for this role should possess a Bachelor's degree in health services administration, health informatics, or a related field, and at least 5 years of experience in the healthcare industry. You should have a solid understanding of medical management concepts, including utilization management, case management, and quality improvement. Additionally, you should have strong project management skills and experience in data analysis. Ideal candidates should have excellent problem-solving and communication skills, be highly organized, and have the ability to collaborate with team members. If you are ready to make a difference in the lives of our members and join a team of dedicated healthcare professionals, please apply today!

Responsibilities:

1. Manage utilization, case, and quality improvement programs for members.
2. Analyze data to identify trends and recommend solutions to improve healthcare services.
3. Develop and implement strategies to improve the quality and cost-effectiveness of healthcare services.
4. Monitor medical management processes to ensure compliance with regulations and standards.
5. Prepare reports and present findings to management.
6. Collaborate with team members to develop best practices and policies.
7. Educate members on medical management processes and procedures.
8. Stay up to date on new developments in the healthcare industry.
9. Handle incoming calls and inquiries from members.
10. Perform other duties as assigned.

According to JobzMall, the average salary range for a Medical Management Specialist in St. Louis, MO, USA is between $40,868 and $90,159 per year. The salary range is dependent on factors such as experience, education, and certifications.

Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.