Remote UM Compliance Coordinator III — Data-Driven

Humana Inc; Trenton (NJ); Remote; USD 45,000 - 60,000; Full time

Job summary

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role requires independent judgment, with a four-day workweek and shifts between 8:00 a.m.

and 8:00 p.m. ET, Wednesday-Sunday or Thursday-Sunday. You will analyze data daily to assess metrics, follow guidelines for QIO fast track appeals, and work in an agile team environment to improve consumer experiences.

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.

Responsibilities

• Reviews utilization management activities and documentation for compliance with policies and regulations.
• Collects and analyzes data to assess outcome and operational metrics.
• Follows guidelines for processing QIO fast track appeals and expedited authorization requests.

Skills

Tech experience

Word & Excel

Attention to detail

Healthcare clerical

Communication skills

Agile work style

Education

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

Tools

Microsoft Word

Microsoft Excel

Job description

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role requires independent judgment, with a four-day workweek and shifts between 8:00 a.m.

and 8:00 p.m. ET, Wednesday-Sunday or Thursday-Sunday. You will analyze data daily to assess metrics, follow guidelines for QIO fast track appeals, and work in an agile team environment to improve consumer experiences.