Utilization Mgmt. Coordinator

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 7:00pmCST/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

As a Utilization Management Administration Coordinator, you will:

• 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.

Performance Goals:
Meet productivity, quality, service, and attendance expectations. Adapt to changing priorities and support both phone and non-phone responsibilities as operational needs evolve.

You will receive cross-training to support multiple lines of business and utilization management functions. Success in this role requires adaptability, strong organizational skills, attention to detail, and a commitment to delivering exceptional service to providers, members, and internal partners.

• 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)

• 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
• Experience with Utilization Review and Prior Authorization
• 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…