Utilization Management Administration Coordinator; SNF

Become a part of our caring community and help us put health first

The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Achieve your best n Us! The UM Administration Coordinator provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.

The Home Solutions UM Team is hiring for a UM Administration Coordinator that will provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members utilizing Home Health and Skilled Nursing Facility services. This team sits in the Home Solutions organization and contributes to the Value-Based segment partnering with Center Well and Onehome.

• Manages NLP's for chart reviews for the nursing team
• Builds and pends authorizations for review
• Responsible for inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day
• Documents calls and attaches clinical information received
• Requests clinical information from providers/facilities
• Creates and sends out written correspondence
• Creates and distributes determination letters
• Collaborates with multiple roles/departments/providers/team members

* REMINDER: ATTACH A COPY OF YOUR RESUME

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 8 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

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

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

• Remote position with possibility of flexible working hours Monday to Friday between 8am and 8pm EST (8 paid hours per business day)
• Overtime available based upon business needs
• Weekend and/or holiday work possible for this role

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
• Wireless, Wired Cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
• Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana…