What are the responsibilities and job description for the UM Administration Coordinator position at Humana?
Become a part of our caring community and help us put health first
Humana Healthy Horizons is seeking a Utilization Management (UM) Coordinator who contributes to the administration of utilization management with role responsibilities in eligibility verification, clinical requests, fax attachments, peer to peer, and member / provider outreach. The UM Coordinator performs computations and varied activities with moderately complex administrative / operational / customer support assignments.
The Utilization Management (UM) Coordinator provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care, or services for members and makes decisions focused on interpretation of area / department policy and methods for completing assignments. The UM Coordinator works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization / timing, and works under minimal direction. The UM Coordinator follows standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.
Key Responsibilities :
Work within the UM team with role responsibilities in eligibility verification, clinical requests, fax attachments, peer to peer, and member / provider outreach which requires answering of departmental phones and responses to departmental voicemail, email, and CGX tasks.
Attach faxes for clinical review.
Request clinical information from providers / facilities.
Make outbound calls daily to providers to verify clinical information, arrange peer to peer discussions between providers and Medical Directors, provide peer to peer status updates to providers.
Make outbound calls daily to members as directed by the clinical team.
Document calls and attach clinical information received.
Manage queues and assign cases.
Ability to multitask and prioritize in a high production environment.
Collaborate with multiple roles / departments / providers / team members.
Contributes to any administration needs of utilization management.
Use your skills to make an impact
Required Qualifications
Must reside in the State of Florida.
1 or more years of administrative or technical support experience in health care or health insurance.
Ability to work Thursday - Sunday, 7 : 00 am - 6 : 00 pm EST (10 hr shifts) with occasional holidays.
Proven working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems.
Experience with providing effective verbal and written communication with both internal and external customers.
Preferred Qualifications
Proficient utilizing electronic medical record and documentation programs.
Proficient and / or experience with medical terminology and / or ICD-10 codes.
Associate degree or higher in business, finance, or a related field.
Prior member service or customer service telephone experience desired .
Experience with Utilization Review and / or Prior Authorization, preferably within a managed care organization.
Minimum 1-year CGX experience.
Additional Information
Workstyle : Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
Core Workdays & Hours : Thursday - Sunday, 7 : 00am - 6 : 00 pm Eastern Standard Time (EST) with occasional holidays
Training : Training will be conducted with the Humana Healthy Horizons Process Improvement Team with transition to the Humana Healthy Horizons Utilization Management Team on a Monday - Friday, 8-hour schedule, then transition to Thursday - Sunday schedule.
WAH Internet Statement
To ensure Home or Hybrid Home / Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office employees 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.
Employees 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 employees 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.
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.
Limited Geography Remote - This is a remote position but located within a specific geography
Scheduled Weekly Hours
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
40,000 - $52,300 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE : HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
Salary : $40,000 - $52,300
