Medical Management Specialist Sr

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)

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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 Wo