Utilization Management Administration Coordinator

Kentucky, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must have at least 1 year of experience in an administrative support role and proficiency with Microsoft Word, Outlook, and Excel, including accurate data entry. The ability to quickly learn new systems is essential. Preferred qualifications include experience with Utilization Review or Prior Authorization in a managed care setting, familiarity with electronic medical records and documentation programs, knowledge of medical terminology and ICD-10 codes, prior customer service experience via phone, and experience with SNF, Home Health, CGX, SRO, HCHB, or in a metric-driven healthcare environment. Remote work requires a minimum internet download speed of 25 Mbps and upload speed of 10 Mbps via a wired, wireless, or DSL connection.

Responsibilities

The Utilization Management Administration Coordinator provides non-clinical support for policies and procedures related to member treatment, care, and services, specifically for Home Health and Skilled Nursing Facility utilization. Key duties include managing NLP for chart reviews, building and pending authorizations, making inbound and outbound calls to providers and members to verify clinical information, documenting calls, requesting and attaching clinical information, creating and sending written correspondence, and distributing determination letters. The role also involves collaborating with various internal and external stakeholders.

Skills

Utilization Management

Administrative Support

Data Entry

Provider Communication

Member Communication

Documentation

Authorization Management

Correspondence Creation

Interdepartmental Collaboration

NLP

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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