[Remote] UM Administration Coordinator at Humana

Indiana, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Must reside in the state of Indiana
1 year of experience in care management or care coordination, LTSS or Utilization Management authorization processes within managed care
Minimum of 2 years healthcare-related experience
Strong critical thinking and problem-solving skills to assess documentation and identify discrepancies
Ability to communicate professionally and effectively with providers, members, and internal stakeholders
Attention to detail with the ability to follow structured workflows and ensure compliance
Experience working with diverse populations and managing sensitive healthcare information
Ability to work independently and collaboratively within a fast-paced environment

Responsibilities

Accurately and efficiently process and enter authorization requests into the system
Review care team submitted service requests and validate required documentation before processing
Coordinate follow-up with the care team for missing or additional required information
Maintain detailed records of authorization approvals, denials, and modifications
Collaborate with UM nurses and care teams to escalate requests requiring additional clinical review
Monitor authorization timelines and turnaround times to prevent delays
Serve as a liaison between providers, members, and internal teams, ensuring smooth communication regarding service approvals
Identify potential discrepancies, errors, or inefficiencies and work proactively to resolve them
Assist with training and onboarding of new team members as needed

Skills

Humana

Health insurance provider for seniors and military

About Humana

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.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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