Medical Management Specialist

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.