Medical Management Specialist I

Elevance Health

. Gather clinical information regarding cases and determine the appropriate area to refer or assign each case .

Posted 9/18/2026full-timeRichmond • Virginia • United StatesJunior💰 $21 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong analytical and problem-solving skills while effectively managing clinical information and facilitating communication between departments. Proficient in customer service and capable of working independently in a remote environment.

Highest-signal resume keywords

Managed Care UnderstandingCustomer Service ExperienceBilingual English-SpanishAnalytical SkillsInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Information GatheringDatabase MaintenanceReport PreparationCase ManagementUtilization Management Exclusion

Soft Skills

Problem-Solving SkillsFacilitation SkillsStrong Oral CommunicationWritten CommunicationMulti-Tasking Ability

Industry Keywords

MedicaidMedicareVirginia ResidencyRemote WorkPatient/Member-Facing Roles

About the role

Key responsibilities & impact

Gather clinical information regarding cases and determine the appropriate area to refer or assign each case
Provide information regarding network providers or general program information when requested
Assist with complex cases
Act as liaison between Medical Management and/or Operations and internal departments
Maintain and update tracking databases
Prepare reports and document all actions
Provide non-clinical support to Medical Management and/or Operations
Exclude utilization management review activities requiring interpretation of clinical information

Requirements

What you’ll need

Virginia residency is required
Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
H.S. diploma or equivalent and a minimum of 1 year experience, or any combination of education and experience providing an equivalent background
Understanding of managed care or Medicaid/Medicare strongly preferred
2 years of previous experience in customer service strongly preferred
Bilingual English-Spanish skills are a plus
Ability to work independently and multi-task in a remote environment
Strong oral, written, and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution / 401(k) match
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual work flexibility
Professional and personal growth opportunities