Utilization Management Coordinator

Ohio, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must have at least one year of administrative or technical support experience and possess excellent verbal and written communication skills. A working knowledge of MS Office (Word, Excel, Outlook) in a Windows environment and the ability to learn new systems quickly are essential. High-speed DSL or Cable modem internet access is required for a home office, with specific speed criteria of at least 25 Mbps download and 10 Mbps upload. Experience with electronic medical records, medical terminology, ICD-10 codes, member/customer service, and utilization review or prior authorization within managed care is preferred. A Bachelor's degree in Business, Finance, or a related field is also preferred.

Responsibilities

The Utilization Management Coordinator provides non-clinical support to UM Nurses and Medical Directors to ensure members receive appropriate treatment and services. This role involves processing requests for health service authorization, interpreting policies, and adhering to quality standards. The coordinator works independently with minimal direction, exercising some latitude in prioritizing tasks and timing.

Skills

Administrative Support

Technical Support

MS Office

Word

Excel

Outlook

Windows

Electronic Medical Records

Medical Terminology

ICD-10 Codes

Member Service

Customer Service

Utilization Review

Prior Authorization

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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