[Hiring] Utilization Management Coordinator @Humana

Role Description

Become a part of our caring community. At Humana, we work collaboratively to provide solutions and fulfill our commitment to serving members. The UM Administration Coordinator role supports UM operations through provider/member-facing phone support and back-office administrative responsibilities. As a UMAC 2, you will report to the Supervisor, UM Management, and support UM processes while working remotely.

Schedule: 8-hour shifts ending no later than 7:00pm CST/8:00 PM EST, including one weekend day (Saturday or Sunday) and holiday rotation. Scheduled breaks and meal periods are assigned to ensure adequate staffing and maintain service levels for providers and members.

Training Schedule: The first month consists of mandatory training conducted Monday through Friday from 8:00 AM to 4:30 PM CST.

Key Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; help providers and members navigate these processes, with approximately 30 to 50 phone interactions daily when assigned to phone support.
• Process and review prior authorization requests and documentation, researching and evaluating information to support medical necessity determinations and authorization workflows.
• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely case processing.
• Review, verify, and enter accurate information across multiple systems; document all interactions, research findings, and case activities while following established procedures, process flows, and work instructions.
• Complete and monitor assigned work queues to meet service level agreements and turnaround time requirements.
• Collaborate with clinical and operational teams and internal partners to resolve issues and address escalated concerns.
• Meet productivity, quality, service, and attendance expectations. Adapt to changing priorities and support both phone and non-phone responsibilities as operational needs evolve.
• Receive cross-training to support multiple lines of business and utilization management functions.

Qualifications

• Minimum of 2 years of customer service experience.
• Experience managing a high-volume of calls (approximately 30 to 50 calls daily) using multiple computer systems while engaging callers.
• Typing proficiency of at least 30 words per minute.
• Proficient experience using Microsoft Office (including using toolbars, menus, and system features to locate documents).
• A direct wired connection to an internet router is required (Wi-Fi is not permitted).
• A dedicated, distraction-free, professional workspace with a closed door (ability to participate in meetings and training with a webcam).

Preferred Qualifications

• Customer service experience within healthcare, insurance, or health services.
• Experience with Utilization Review and Prior Authorization within a managed care organization.
• Proficient using electronic medical record and documentation programs.
• Knowledge of Medical Terminology and ICD-10 codes.

Successful candidates will demonstrate

• Exceptional attendance and reliability.
• Professionalism while working remotely.
• A dedicated and distraction-free workspace.
• Comfort appearing on camera when required.
• Comfort learning complex information through virtual training.
• Strong customer service experience, preferably in healthcare or insurance.
• Knowledge of utilization management concepts, prior authorization processes, and medical coding.
• Ability to learn new systems quickly and adapt to changing business needs.

Requirements

• Work at Home Requirements: A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

• 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

• $40,000 - $52,300 per year

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.