Medical Management Assistant

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