Compliance UMAC 3 (Fri – Mon)

Humana; Denver (CO); À distance; USD 45 000 - 60 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Disability and life insurance

Language interpreter services

Résumé du poste

Humana is hiring a Compliance (UM) Coordinator 3 to join a team that reviews utilization management activities and ensures adherence to policies and regulations. The role involves data analysis and independent judgment within a three-day, 12-hour shift schedule across Friday–Monday.

Responsibilities include handling QIO fast track appeals and expedited authorizations while maintaining accuracy, attention to detail, and strong communication.

Qualifications

• 1–3 years of technical experience.
• Proficient in Microsoft Word & Excel.
• Strong attention to detail and accuracy.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Excellent verbal and written communication skills.
• Clerical support background in a healthcare environment.
• Ability to work independently in an agile environment under general instructions and within a team.

Responsabilités

• Reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations.
• Collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.
• Follows guidelines and procedures for processing QIO fast track appeals and expedited authorization requests.

Connaissances

Microsoft Word

Microsoft Excel

Attention to detail

Written and verbal communication

Independent work in agile environment

Clerical healthcare experience

Formation

Associates’ or Bachelor’s degree in Healthcare, Business, Finance, or related field

Outils

MS Word

MS Excel

Description du poste

Become a part of our caring community

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

PLEASE NOTE: This role will follow a three-day, 12-hour shift schedule within a Friday to Monday work week. The assigned schedule will be either Friday – Sunday or Sunday – Monday, with work hours scheduled between 8:00 a.m. and 9:00 p.m. Eastern Time.

The Compliance (UM) Coordinator 3 collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action. Follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

Use your skills to make an impact

Required Qualifications

• 1 – 3 years of technical experience

• Proficient in Microsoft Word & Excel

• Strong attention to detail and accuracy

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

• Excellent verbal and written communication skills

• Clerical support background in a healthcare environment

• Ability to work independently in an agile environment under general instructions and within a team.

Preferred Qualifications

• UM experience with auditing or compliance

• UM experience with processing expedited requests or QIO appeals

• The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12 months

• Associates’ or Bachelor’s degree in Healthcare, Business. Finance, or related field

• Familiarity with medical terminology and/or ICD-10 codes

Additional Information

• This position is within a department that operates in EST.

• This position features a three-day workweek consisting of 12-hour shifts , with schedule options of Friday–Sunday or Saturday–Monday.

Work-At-Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).

• A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.

• Check your internet speed at www.speedtest.net

• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information

Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

Scheduled Weekly Hours

40

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.

$44,900 – $60,200 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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 protected veteran status.

It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.