Remote Utilization Management Coordinator

Humana, Inc.; Santa Fe (NM); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a remote UM Administration Coordinator to support UM operations through provider/member-facing phone support and back-office administration.

The role reports to the Supervisor, UM Management, and includes training, weekend/holiday rotation, and cross-training across lines of business. Requirements include 2+ years of customer service, 30–50 daily calls, 30 wpm typing, MS Office proficiency, wired internet, and a dedicated quiet workspace with webcam.

Qualifications

• Minimum of 2 years of customer service experience.
• Experience managing a high-volume of calls (approximately 30 to 50 calls daily) using multiple computer systems while engaging callers.
• Typing proficiency of at least 30 words per minute.
• Proficient experience using Microsoft Office (including using toolbars, menus, and system features to locate documents).
• A direct wired connection to an internet router is required (Wi-Fi is not permitted).
• A dedicated, distraction-free, professional workspace with a closed door (ability to participate in meetings and training with a webcam).

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; help providers and members navigate these processes, with approximately 30 to 50 phone interactions daily when assigned to phone support.
• Process and review prior authorization requests and documentation, researching and evaluating information to support medical necessity determinations and authorization workflows.
• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely case processing.
• Review, verify, and enter accurate information across multiple systems; document all interactions, research findings, and case activities while following established procedures, process flows, and work instructions.
• Complete and monitor assigned work queues to meet service level agreements and turnaround time requirements.
• Collaborate with clinical and operational teams and internal partners to resolve issues and address escalated concerns.

Skills

Customer service

High-volume calls

Typing 30 wpm

Microsoft Office

Wired internet

Dedicated workspace

Remote work readiness

Tools

Microsoft Office

Job description

Humana, Inc. is seeking a remote UM Administration Coordinator to support UM operations through provider/member-facing phone support and back-office administration.

The role reports to the Supervisor, UM Management, and includes training, weekend/holiday rotation, and cross-training across lines of business. Requirements include 2+ years of customer service, 30–50 daily calls, 30 wpm typing, MS Office proficiency, wired internet, and a dedicated quiet workspace with webcam.