Remote Compliance UM Coordinator | Data-Driven 3-Day Week

Humana Inc; City of Albany (NY); À distance; USD 45 000 - 60 000; Plein temps

Résumé du poste

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies and regulations.

The role includes data collection and analysis, with independent decision-making and interpretation of guidelines to determine actions. Ideal candidates will have 1–3 years of technical experience, be proficient in Word & Excel, and possess strong communication skills.

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

• Review utilization management activities and documentation to ensure adherence to policies, procedures, and regulations.
• Collect and analyze data daily, weekly, or monthly to assess outcomes and metrics for the team and individuals.
• Make decisions regarding own work methods, often in ambiguous situations, with minimal direction.
• Follow guidelines and regulatory turnaround times for processing QIO fast track appeals and expedited authorization requests.

Connaissances

Technical experience

Formation

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

Outils

Microsoft Word

Excel

Description du poste

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies and regulations.

The role includes data collection and analysis, with independent decision-making and interpretation of guidelines to determine actions. Ideal candidates will have 1–3 years of technical experience, be proficient in Word & Excel, and possess strong communication skills.