Utilization Management Administration Coordinator - SNF

** Become a part of our caring community*
* 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. You are part of the Home Solutions organization, which contributes to the Skilled Nursing Facility segment. This segment partners with Center Well and Onehome.

As a Utilization Management Administration Coordinator, you will work within defined parameters to meet work expectations and quality standards.

+ You will manage NLP's for chart reviews for the nursing team

+ You will build and pend authorizations for review

+ You will perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day and will document completed calls and attach clinical information received.

+ You will request clinical information from providers/facilities

+ You will create written correspondence

+ You will create and distribute determination letters

+ And you will collaborate with multiple roles/departments/providers/team members

** Use your skills to make an impact*
* *
* Required Qualifications:

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* + 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

+ Ability to new systems (proficient to advanced)

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* Preferred Qualifications:

*
* +

Experience with Utilization Review or Prior Authorization within a managed care organization

+ Proficient using electronic medical record and documentation programs

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Experience with medical terminology or ICD-10 codes

+ Prior member service or customer service telephone experience

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Experience with SNF or Home Health

+ Prior experience with CGX, SRO and HCHB

+ Prior experience in a metric driven environment

+ Prior experience in the healthcare industry

** Additional Information*
* ** Work-at-Home Information:*
* 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.

+ Satellite, cellular and microwave connection can be used only if approved by leadership.

+ Employees 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 will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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.

** Scheduled Weekly Hours*
* 40

** Pay Range*
* The compensation range below reflects a good faith estimate…