Remote Utilization Management Coordinator

Humana; Pierre (SD); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana, a leading U.S. healthcare company, is seeking an UM Administration Coordinator to support utilization management operations remotely. The role includes provider/member phone support, back-office tasks, and cross-training across lines of business.

The position requires strong customer service, the ability to handle 30–50 calls daily, and proficiency with EMR systems. A wired internet connection and a dedicated, quiet workspace are essential.

Qualifications

• Minimum of 2 years of customer service experience.
• Handle inbound/outbound calls (30–50 daily) using multiple computer systems.
• Typing proficiency of at least 30 words per minute.
• Proficient use of Microsoft Office.
• A direct wired internet connection is required (Wi‑Fi not allowed).
• A dedicated, distraction-free workspace with webcam for meetings/trainings.

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits.
• Process and review prior authorization requests and documentation for medical necessity determinations.
• Perform back-office administrative tasks including case research and data updates.
• Verify and enter information across systems; document interactions and findings.
• Complete and monitor work queues to meet SLAs and turnaround times.
• Collaborate with clinical and operational teams to resolve issues.

Skills

Customer service

High-volume calls

Typing 30 WPM

Microsoft Office

Wired internet

Dedicated workspace

Tools

EMR software

Job description

Humana, a leading U.S. healthcare company, is seeking an UM Administration Coordinator to support utilization management operations remotely. The role includes provider/member phone support, back-office tasks, and cross-training across lines of business.

The position requires strong customer service, the ability to handle 30–50 calls daily, and proficiency with EMR systems. A wired internet connection and a dedicated, quiet workspace are essential.