Medical Management Specialist (LTSS Support)

Absolute Staffing & Consulting Solutions - Providence, RI, United States

 Absolute Staffing is searching for a Medical Management Specialist to work with our client.

Job Location: RI, MA or CT

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.
  • Requires a high school diploma and a minimum of 1 year experience or any combination of education and experience which would provide an equivalent background.
  • Understanding of managed care or Medicaid/Medicare strongly preferred.

For URAC accredited areas, the following professional competencies apply:

  • Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Posted On: Monday, February 26, 2024

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