Anticipated End Date:

2026-05-22

Position Title:

Medical Management Specialist Sr

Job Description:

Location: This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

This position is not eligible for employment based sponsorship.

The Medical Management Specialist Sr. is responsible for providing non-clinical support to medical management operations, which includes handling the most complex file reviews and inquiries from members and providers. Provides mentoring and leadership to other medical management specialists.

How you will make an impact:

Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Conducts initial review of files to determine appropriate action required.
Maintains and updates tracking databases.
Prepares reports and documents all actions.
Responds to requests, calls or correspondence within scope.
Provides general program information to members and providers as requested.
May review and assist with cases.
May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

Minimum Requirements:

Requires a H.S. diploma or equivalent and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experience:

Knowledge of managed care or Medicaid/Medicare concepts strongly preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $28.70/hour to $43.06/hour

Locations: District of Columbia (Washington, DC)

Anticipated End Date:

2026-05-22

Position Title:

Medical Management Specialist Sr

Job Description:

This position is not eligible for employment based sponsorship.

How you will make an impact:

Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Conducts initial review of files to determine appropriate action required.
Maintains and updates tracking databases.
Prepares reports and documents all actions.
Responds to requests, calls or correspondence within scope.
Provides general program information to members and providers as requested.
May review and assist with cases.
May collaborate with external community-based organizations to facilitate and coordinate care under the direction of an RN Case Manager.

Minimum Requirements:

Requires a H.S. diploma or equivalent and a minimum of 5 years administrative and customer service experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experience:

Knowledge of managed care or Medicaid/Medicare concepts strongly preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $28.70/hour to $43.06/hour

Locations: District of Columbia (Washington, DC)

Medical Management Specialist Sr

Medical Management Specialist Sr

Elevance Health

Elevance Health

Benefits

Elevance Health