Utilization Management Administration Coordinator

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. The UM Administration Coordinator 2 contributes to the administration of utilization management. The UM Administration Coordinator 2 performs basic administrative, clerical, operational, customer support, and computational tasks working on semi-routine and patterned assignments.

The UM Administration Coordinator 2 provides non-clinical support, following established policies and procedures, ensuring the best and most appropriate treatment, care, or services for members.

Prepares and forwards authorization requests to clinical review. Works within defined parameters to identify work expectations and quality standards, but has some autonomy over prioritization/timing, and works under minimal direction.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Key Responsibilities

• Completes inbound and outbound provider calls to answer UM-related questions and prepare authorization requests for clinical review.
• Document calls and attach clinical information to the member’s medical record.
• Create and send out written correspondence.
• Ability to multitask and prioritize.
• Collaborate with multiple roles/departments/providers/team members.
• Use your skills to make an impact.

Required Qualifications

• Minimum 1 year healthcare or clinical experience (working for a health plan, organization, or provider).
• Excellent verbal and written communication skills.
• Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment.

Preferred Qualifications

• Proficient utilizing electronic medical record and documentation programs.
• Prior member service or customer service telephone experience desired.
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.
• Clerical support background in a healthcare environment.
• Familiarity with medical terminology and/or ICD-10 codes.
• CNA or Medical Assistant background a plus.

Additional Information

Workstyle: Remote work at home Location: Multiple Locations

Training/Work Schedule: Must be able to attend the training schedule. Monday through Friday; 8:00 AM - 5:00 PM Central/Eastern Time (based on residence).

Travel: Minimal travel for office meetings 1-2 times annually.

Work at Home Guidance: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Hire Vue interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recor