Medical Management Specialist I/ PHRN

Position Title:

Medical Management Specialist I/ PHRN

Shift:

Not specified

Job Description:

Responsible for providing non-clinical support to the Medical Management and/or Operations areas.

Primary duties include:

• Gathers clinical information regarding a case and determines appropriate area to refer or assign it (utilization management, case management, QI, Med Review).
• Provides information regarding network providers or general program information when requested.
• Assists with complex cases.
• Acts as liaison between Medical Management and/or Operations and internal departments.
• Maintains and updates tracking databases.
• Prepares reports and documents all actions.

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

Qualifications: Requires a current Philippines ...