Utilization Management Physician Reviewer
Blank StreetFull Time
Senior (5 to 8 years)
Candidates must possess a high school diploma, strong attention to detail, and excellent typing and computer navigation skills. They should be able to manage multiple competing priorities, use multiple computer applications simultaneously, and have working knowledge of MS Office (Word, Excel, Outlook) in a Windows environment. Prior experience in administrative or technical support is required, along with excellent verbal and written communication skills and a passion for improving consumer experiences. An Associate or bachelor's degree, previous contact center or customer service experience, healthcare experience, proficiency with electronic medical records, medical terminology, ICD-10 codes, and utilization review or prior authorization are preferred.
The UM Administration Coordinator 1 contributes to the administration of utilization management by performing basic administrative, clerical, operational, customer support, and computational tasks. This role provides non-clinical support for policies and procedures to ensure appropriate treatment, care, and services for customers, working under close supervision within defined parameters and established guidelines.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.