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.

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.

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

• 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.

• 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

• 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.

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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$40,000 - $52,300 per year