Remote Utilization Management Compliance Coordinator (4x10)

Humana Inc; Austin (TX); Remote; USD 45,000 - 60,000; Full time

Job summary

Humana Inc. seeks a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role demands independent judgment and data interpretation, with responsibilities including data analysis and processing of QIO fast track appeals and expedited authorizations.

The position follows a four-day, 10-hour shift schedule in EST, with Wed-Sat or Thu-Sun options and travel possible for training or meetings.

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

• Review utilization management activities and documentation.
• Collect and analyze data daily, weekly, monthly, or as needed to assess metrics.
• Follow guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorizations.
• Make independent judgments and interpret guidelines within a healthcare setting.

Skills

Technical experience

Microsoft Word & Excel

Attention to detail

Communication skills

Clerical support (healthcare)

Independent work

Agile environment

Team collaboration

Education

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

Job description

Humana Inc. seeks a Compliance (UM) Coordinator 3 to review utilization management activities and ensure adherence to policies, procedures, and regulations. The role demands independent judgment and data interpretation, with responsibilities including data analysis and processing of QIO fast track appeals and expedited authorizations.

The position follows a four-day, 10-hour shift schedule in EST, with Wed-Sat or Thu-Sun options and travel possible for training or meetings.