Remote Utilization Management Compliance Coordinator III

Humana Inc; Concord (NH); 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 requires independent judgment in a healthcare setting and supports continued improvements in consumer experiences.

The position follows a four-day, 10-hour shift schedule (Wednesday-Sunday or Thursday-Sunday) with hours between 8:00 a.m. and 8:00 p.m. ET. Remote work is possible with occasional travel to Humana offices as needed.

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 for adherence to policies, procedures, and regulations.
• Collects and analyzes data to assess outcome and operational metrics for the team and individuals.
• Make decisions regarding own work methods, often in ambiguous situations, with minimal direction.
• Follow guidelines for processing QIO fast track appeals and expedited authorization requests.

Connaissances

Technical experience

Microsoft Word

Microsoft Excel

Attention to detail

Communication skills

Independent work

Agile environment

Formation

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

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 requires independent judgment in a healthcare setting and supports continued improvements in consumer experiences.

The position follows a four-day, 10-hour shift schedule (Wednesday-Sunday or Thursday-Sunday) with hours between 8:00 a.m. and 8:00 p.m. ET. Remote work is possible with occasional travel to Humana offices as needed.