Compliance UMAC ; Fri - Mon

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Compliance (UM) Coordinator 3 collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related work streams. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action.

Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

• 1 - 3 years of technical experience

• Proficient in Microsoft Word & Excel

• Strong attention to detail and accuracy

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Excellent verbal and written communication skills

• Clerical support background in a healthcare environment

• Ability to work independently in an agile environment under general instructions and within a team.

• UM experience with auditing or compliance

• UM experience with processing expedited requests or QIO appeals

• The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months

• Associates' or Bachelor's degree in Healthcare, Business. Finance, or related field

• Familiarity with medical terminology and/or ICD-10 codes

• This position is within a department that operates in EST.

• This position features a three-day workweek consisting of 12-hour shifts , with schedule options of Friday–Sunday or Saturday–Monday.

• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).

• A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.

• Check your internet speed at

• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and 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.