[Hiring] Utilization Management Administration Coordinator @Humana

Role Description

The UM Administration Coordinator (UMAC) provides non-clinical support for policies ensuring the most appropriate treatment, care or services for members using services. Reporting to the Manager of Utilization Management, you will work fully remote as part of the Home Solutions organization, which contributes to the Skilled Nursing Facility segment.

• Manage NLP's for chart reviews for the nursing team.
• Build and pend authorizations for review.
• Perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status.
• Document completed calls and attach clinical information received.
• Request clinical information from providers/facilities.
• Create written correspondence.
• Create and distribute determination letters.
• Collaborate with multiple roles/departments/providers/team members.

Qualifications

• 1+ years' experience working in an administrative support capacity.
• Prior professional experience with Microsoft Word, Outlook, and Excel with the ability to type and enter data.
• Ability to learn new systems (proficient to advanced).

Requirements

• Experience with Utilization Review or Prior Authorization within a managed care organization (preferred).
• Proficient using electronic medical record and documentation programs (preferred).
• Experience with medical terminology or ICD-10 codes (preferred).
• Prior member service or customer service telephone experience (preferred).
• Experience with SNF or Home Health (preferred).
• Prior experience with CGX, SRO, and HCHB (preferred).
• Prior experience in a metric-driven environment (preferred).
• Prior experience in the healthcare industry (preferred).

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.
• Many other opportunities for personal wellness and smart healthcare decisions.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.