Medical Management Specialist I or II- Remote in GA, FL, NY, VA- PS32825

The Job Holder
Georgia, USA
Feb 06, 2020

Client Name

Anthem, Inc.

Requirements

Your Talent. Our Vision. At Anthem, Inc., it's a ground-breaking mix, and the establishment whereupon we're making more noteworthy access to think about our individuals, more prominent incentive for our clients and more prominent wellbeing for our networks. Combine us and we will drive the eventual fate of medicinal services. 

This is an extraordinary chance to do inventive work that implies more to you and those we serve at one of America's driving medical advantages organizations and a Fortune Top 50 Company. 

Therapeutic Management Specialist I or II (Remove in GA, FL, NY or VA) 

If you don't mind note: This position will be filled at either the I or II level. The procuring director will decide the proper level dependent on the chose candidate's understanding and range of abilities comparative with the capabilities recorded for this position. 

This position may, in the long run, require the end of the week work. 

LEVEL I 

  • This job is liable for giving non-clinical help to the Medical Management or potentially Operations regions. Essential obligations may incorporate, however, are not restricted to: 
  • Accumulates clinical data in regards to the case and decides suitable region to allude or relegate case (use the board, case the executives, QI, Med Review). 
  • Gives data with respect to organize suppliers or general program data when mentioned. 
  • May help with complex cases. 
  • May go about as contact between Medical Management and additionally Operations and inward divisions. 
  • Keeps up and refreshes the following databases. 
  • Gets ready reports and archives all activities. 
  • Obligations avoid leading any use of the executive's audit exercises which require translation of clinical data. 

LEVEL II 

  • This job is answerable for giving non-clinical help to therapeutic administration tasks, which incorporates taking care of progressively complex record surveys and requests from individuals and suppliers. Essential obligations may incorporate, yet are not restricted to: 
  • Assembles clinical data in regards to the case and decides fitting region to allude or allot case (use the executives, case the board, QI, Med Review). 
  • Behaviors starting an audit of records to decide the proper activity required. Keeps up and refreshes the following databases. 
  • Gets ready reports and archives all activities. 
  • Reacts to solicitations, calls or correspondence inside the extension. 
  • Gives general program data to individuals and suppliers as mentioned. 
  • May audit and help with cases. 
  • Goes about as contact between therapeutic administration tasks and other interior offices to help simplicity of organization of health advantages. May help with the case referral process. 
  • May team up with outer network-based associations to encourage and arrange care under the course of an RN Case Manager. 
  • For California Children Services: May demand medicinal records from suppliers, may finish and submit CCS referral to neighborhood CCS program on the same date of recognizable proof of potential CCS qualified condition. 
  • Tracks referral as indicated by indicated courses of events and tells suppliers and groups of CCS qualification conclusions and referrals, BCC approvals as well as deferrals. 
  • Duties reject directing any use the board audit exercises which require an understanding of clinical data