Medical Management Specialist I - Ohio MyCare

Anticipated End Date:

2025-09-27

Position Title:

Medical Management Specialist I - Ohio MyCare

Job Description:

The MyCare Ohio Plan program is to deliver high‐quality, trauma informed, culturally competent, person‐centered coordination for all members that addresses physical health, behavioral health, long term services and supports, and psychosocial needs.

Medical Management Specialist I

Location: This role requires associates to be in-office 1 - 2 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. This role is based in Ohio with positions located in either the Columbus, Cincinnati, Mason, or Seven Hills area.

Ohio residency is a requirement for this position.

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.

Schedule:  This position will work an 8-hour from shift 8:00 am - 5:00 pm (EDT) Monday to Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Receive incoming member and provider calls and provide support with basic information and triage other issues to the appropriate location
• Gather clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
• Provide information regarding network providers or general program information when requested.
• Conduct member and provider outreach to follow up on activities of care coordination.
• Confirm service initiation and coordinate service delivery
• Support Care Coordinators with scheduling visits and collecting information from providers
• Help members with scheduling transportation and accessing community resources
• Facilitate exchanges of documentation between interdisciplinary teams
• May assist with complex cases.
• Prepares reports and documents all actions.

Minimum Requirements:

• Requires a H.S. diploma or equivalent 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:

• Understanding of managed care or Medicaid/Medicare strongly preferred.

• Call center or other phone based customer service experience 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.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

MED > Medical Ops & Support (Non-Licensed)

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consum