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 authorizing services while working remotely for approximately 3-6 months.

Key responsibilities

• Authorize and process claims for inpatient and outpatient services by entering data and triaging events according to departmental guidelines
• Verify member data and eligibility by researching participation in SCAN Care Management Programs and network provider status
• Maintain effective communication with internal and external customers, ensuring services align with benefit plans and fostering professional relationships with providers

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