Utilization Management Administration Coordinator

San Antonio, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Managed CareIndustries

Requirements

Candidates must possess a minimum of 1 year of experience in the healthcare or clinical field, demonstrating excellent verbal and written communication skills. A working knowledge of MS Office Suite (Word, Excel, Outlook) within a Windows environment is essential, along with the ability to quickly learn new systems and troubleshoot basic technical issues remotely. Prior experience with electronic medical records, member/customer service via telephone, Utilization Review, Prior Authorization within managed care, or a clerical support background in healthcare is preferred, as is familiarity with medical terminology and ICD-10 codes. A CNA or Medical Assistant background is a plus.

Responsibilities

The Utilization Management Administration Coordinator will handle inbound and outbound provider calls to address utilization management inquiries and prepare authorization requests for clinical review. Responsibilities include documenting calls, attaching clinical information to member records, and creating/sending written correspondence. The role involves multitasking, prioritizing tasks, and collaborating with various roles, departments, providers, and team members to provide non-clinical support in accordance with established policies and procedures.

Skills

Healthcare experience

Clinical experience

Verbal communication

Written communication

MS Office

MS Word

MS Excel

MS Outlook

Windows

Technical troubleshooting

Electronic medical record systems

Member service

Customer service

Utilization Review

Prior Authorization

Managed care

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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