The Medical Management Specialist will handle inbound member calls, triage needs, and provide non-clinical support and resource referrals. They are responsible for maintaining tracking databases, preparing reports, and coordinating with internal departments to ensure proper case assignment.
The specialist provides non-clinical support to medical management operations by handling complex file reviews and inquiries from members and providers. They also maintain tracking databases, prepare reports, and act as a liaison between internal departments and external organizations.
Conduct outreach to Medicaid members to identify barriers to care, explain benefits, support appointment scheduling, and connect members with healthcare and community resources. Document interactions and outcomes, refer complex needs appropriately, and support health plan quality initiatives and efforts to close gaps in care.
