Medical Management Assistant

Job Summary

Supporting the Utilization Management team, the full-time Medical Management Assistant will manage approval determinations, assist in the medical review process, and provide customer service to patients and providers, with the option to work remotely or in-person from designated offices.

Key responsibilities

• Provides notification to nursing staff regarding requests and hospitalizations requiring further review
• Makes approval determinations based on written protocols and guidelines, referring medical questions to nursing staff
• Assists in the medical review process by obtaining necessary documentation for referrals, prior authorizations, and claims reviews

Required qualifications

• High school diploma or equivalent
• 1+ year of experience in a healthcare environment, such as claims processing or medical billing
• Experience with computer applications like MS Office and/or Epic
• Knowledge of medical terminology and familiarity with NCQA requirements is preferred
• Prior data entry and word processing experience is preferred