Medical Management Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $18 - $19 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Professional Management Enterprises (PME)

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

📦 Logistics

🎖️ Defense

Healthcare • Logistics • Defense

Professional Management Enterprises (PME) is a multifaceted professional service and personnel staffing company established in 2006. As a Minority and Service Disabled Veteran Owned Business, PME operates in multiple states, partnering with major corporations such as Humana, KPMG, Ernst and Young, Anthem, and HP. The company specializes in staffing, recruiting, and providing services across various sectors, including healthcare, information technology, and administrative support. PME is a key service provider for the Department of Defense and other Federal Government clients, and it leverages its expertise in healthcare, managed care, IT, and human capital services to deliver flexible and high-performing solutions.

📋 Description

• Provide non-clinical support to medical management operations calls • Handle complex file reviews and inquiries from members and providers • Gather clinical information and determine the appropriate area for case referral or assignment • Conduct initial file reviews to determine required action • Maintain and update tracking databases • Prepare reports and document all actions • Respond to requests, calls, and correspondence within scope • Provide general program information to members and providers • Review and assist with cases • Collaborate with external community-based organizations to facilitate and coordinate care under an RN Case Manager's direction • Act as liaison between medical management operations and internal departments • Provide mentoring and work direction to lower-level associates

🎯 Requirements

• High school diploma • Minimum of 5 years administrative and customer service experience, or any combination of education and experience providing an equivalent background • Knowledge of managed care or Medicaid/Medicare concepts strongly preferred • Strong customer service/call center skills • Ability to work Monday–Friday, 8am–5pm • Ability to complete training

🏖️ Benefits

• Medical, dental, and vision insurance offered • Supplemental insurance • 80 hours of PTO after 90 days • 10 paid holidays • Work-from-home opportunity