California Licensed Medical Management Assistant

Job Summary

Supporting the Medical Management department, the full-time California Licensed Medical Management Assistant will manage provider communications, enter data into the case management system, and assist clinical staff in authorizing services while working remotely from Monday to Friday, 8 am to 5 pm Pacific Time.

Key responsibilities

• Authorize and process claims for inpatient and outpatient services by entering data and triaging events according to department guidelines
• Verify member data, including eligibility and participation in care management programs, while maintaining confidentiality
• Provide professional customer service and support to internal and external customers, ensuring effective communication and timely responses

Required qualifications

• High School Diploma or equivalent required; Associate's Degree or equivalent experience preferred
• 3+ years of medical experience in a managed care environment preferred
• Proficiency with data entry and knowledge of medical terminology required
• Utilization Management experience is required
• Familiarity with ICD-9, CPT coding, and Medicare/Medi-Cal guidelines preferred