California Medical Management Assistant

Job Summary

Supporting the Medical Management department, the full-time temporary California Medical Management Assistant will manage provider communications, enter data into the case management system, and assist clinical staff in ensuring quality care for SCAN members while working remotely for approximately 3-6 months.

Key responsibilities

• Authorize, monitor, and process claims for inpatient and outpatient services by entering data and triaging events according to departmental guidelines
• Verify member data by researching eligibility, participation in care management programs, and provider status
• Maintain effective communication with internal and external customers, ensuring services align with benefit plans and contractual obligations

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
• Working knowledge of Medicare and Medi-Cal guidelines preferred