Utilization Management Physician Reviewer
Blank StreetFull Time
Senior (5 to 8 years)
Candidates must have at least one year of administrative or technical support experience in an office environment, excellent verbal and written communication skills, and be self-motivated with strong self-discipline. A working knowledge of MS Office (Word, Excel, Outlook) in a Windows environment and the ability to learn new systems quickly are required. The position requires residency in Louisiana, a 40-hour work week with potential weekend rotations and overtime, and reliable internet service with at least 25 Mbps download and 10 Mbps upload speeds. Preferred qualifications include proficiency with electronic medical records, medical terminology, ICD-10 codes, an Associate's degree, prior member/customer service experience, and experience with Utilization Review or Prior Authorization in managed care.
The UM Administration Coordinator 2 performs varied and moderately complex administrative and operational tasks, including computations, to support the administration of utilization management. This role provides non-clinical support for policies and procedures, ensuring members receive the best treatment and care. The coordinator interprets area/department policies, works within defined parameters to meet quality standards, and has some latitude in prioritizing tasks and timing under minimal direction. They follow standard practices with some opportunity for interpretation and independent discretion.
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.