Remote UM Compliance Coordinator III – Data-Driven Impact

Humana Inc; Salt Lake City (UT); A distancia; USD 45.000 - 60.000; Jornada completa

Descripción de la vacante

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role involves data analysis and independent decision-making within a structured environment.

Responsibility includes handling QIO fast track appeals, expedited authorizations, and maintaining rigorous standards for accuracy and timeliness in a 3-day, 12-hour shift pattern within a Friday–Monday week and EST hours.

Formación

• 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.

Responsabilidades

• Reviews utilization management activities and documentation for compliance with policies, procedures, and regulations.
• Analyzes data daily, weekly, monthly to assess outcomes and metrics for the team.
• Makes decisions with independent judgment and interprets guidelines to determine action.
• Follows guidelines, regulatory turnaround times, and processes for QIO fast track appeals and expedited authorizations.

Conocimientos

Technical experience

Microsoft Word

Microsoft Excel

Attention to detail

Communication

Clerical support

Independent work

Agile environment

Educación

Associates or Bachelor’s degree in Healthcare/Business/Finance

Descripción del empleo

Humana Inc. is seeking a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role involves data analysis and independent decision-making within a structured environment.

Responsibility includes handling QIO fast track appeals, expedited authorizations, and maintaining rigorous standards for accuracy and timeliness in a 3-day, 12-hour shift pattern within a Friday–Monday week and EST hours.