Medical Management Specialist

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

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

Job Location: Providence, RI

Medical Management Specialist I

The Medical Management Specialist I is 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.

Minimum Requirements:

    • 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.

Preferred Skills, Capabilities and Experiences:

    • Strong working knowledge of Microsoft office products (especially Excel and Teams) strongly preferred.
    • 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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