Remote Prior Authorization & UM Coordinator

Humana, Inc.; Madison (WI); Remoto; USD 40.000 - 52.000; Tempo integral

Benefícios oferecidos por esta vaga

Remote work

Office space on an as-needed basis

Resumo da vaga

Humana, Inc. is seeking a Utilization Management (UM) Coordinator to support the Wisconsin Medicaid iCare program with non-clinical tasks ensuring appropriate care and services for members.

The role focuses on PA processing, information gathering from providers, and coordinating with clinical teams. Responsibilities include documenting PA requests, data entry in TruCare, and maintaining communications with providers and internal staff.

Qualificações

• 1 year of experience in a health care setting or health plan setting.
• 1–2 years of experience with Microsoft Office applications (Word, Excel, PowerPoint).
• 1 year of customer service experience with inbound and outbound calls.

Responsabilidades

• Process and document all incoming inpatient and outpatient prior authorization (PA) requests.
• Contact providers by phone or fax to request additional information per process.
• Conduct inbound and outbound calls.
• Communicate status of PA requests to customers/providers and respond to provider inquiries.
• Enter PA requests into the TruCare database and route to clinical staff for review.
• Multitask throughout the day to meet stakeholder needs.

Conhecimentos

Customer service

Microsoft Word

Microsoft Excel

PowerPoint

Healthcare experience

Ferramentas

TruCare

Descrição da vaga

Humana, Inc. is seeking a Utilization Management (UM) Coordinator to support the Wisconsin Medicaid iCare program with non-clinical tasks ensuring appropriate care and services for members.

The role focuses on PA processing, information gathering from providers, and coordinating with clinical teams. Responsibilities include documenting PA requests, data entry in TruCare, and maintaining communications with providers and internal staff.