Remote Compliance UM Coordinator 3: Data & Policy Review

Remote Jobs; United States; Remote; USD 45,000 - 60,000; Full time

Job summary

Humana is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies and regulations. The role emphasizes independent judgment and data-driven decision making within a remote environment.

The position supports a four-day, 10-hour schedule (Wed–Sat or Thu–Sun) with hours between 8:00 a.m. and 8:00 p.m. EST, and requires strong attention to detail, excellent communication, and healthcare clerical experience.

Qualifications

• 1–3 years of technical experience.
• Proficient in Microsoft Word & Excel.
• Strong attention to detail and accuracy.
• Passionate about improving consumer experiences.
• Excellent verbal and written communication.
• Clerical support background in a healthcare environment.
• Ability to work independently in an agile environment.

Responsibilities

• Review utilization management activities and documentation for policy adherence.
• Interpret guidelines and determine appropriate actions in ambiguous situations.
• Follow guidelines and turnaround times for QIO fast track appeals and expedited requests.
• Collect and analyze data to assess team and individual metrics.
• Adapt to a four-day, 10-hour shift schedule (Wed–Sun or Thu–Sun).

Skills

Tech experience

Word & Excel

Attention to detail

Communication

Independent work

Agile environment

Education

Associates/Bachelor's in Healthcare/Business/Finance

Job description

Humana is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies and regulations. The role emphasizes independent judgment and data-driven decision making within a remote environment.

The position supports a four-day, 10-hour schedule (Wed–Sat or Thu–Sun) with hours between 8:00 a.m. and 8:00 p.m. EST, and requires strong attention to detail, excellent communication, and healthcare clerical experience.