Medical Management Specialist

Medical Management Specialist (Non-Clinical) Remote

Location: Indiana (Must reside within 50 miles of the Indianapolis)
Position Type: Long term Contract
Hourly Rate: $19.00
Number of Openings: 2

BKG is seeking two Medical Management Specialists (Non-Clinical) to join our team in support of the IN Medicaid Health Plans. This is a provider-facing role with responsibilities to assist with utilization management by gathering clinical information and assigning cases to appropriate departments. This is an excellent opportunity to help mitigate social drivers that negatively impact members’ overall health while engaging with providers, community organizations, and family supports.

Key Responsibilities:

• Gather clinical information for case creation and assign or refer cases (e.g., utilization management, case management, QI, Med Review).
• Assist with prior authorization requests for outpatient pre-service utilization management.
• Engage with providers and assist in resolving concerns.
• Provide information regarding network providers or general program information.
• Assist with complex cases and collaborate across departments as needed.
• Maintain and update tracking databases, prepare reports, and document all actions.
• Provide support for inbound provider calls during call rotations.
• Ensure compliance with utilization management best practices, excluding clinical interpretation activities.

Requirements:

• High School Diploma or equivalent required.
• Minimum of 1 year of relevant experience in managed care, Medicaid/Medicare, or a related field preferred.
• Strong organizational and communication skills.
• Availability for weekend coverage every 6-8 weeks and holiday coverage as needed.
• Strong computer skills are a must
• Provider communication experience necessary

Work Schedule:

• Full-time remote M-F 8am-5pm. This position does require weekend coverage every 8 weeks and may require holiday coverage as necessary.

Interested candidates must reside within 50 miles of the Indianapolis. If you are committed to making a positive impact on healthcare outcomes and are excited to support our mission, we encourage you to apply.