Remote Utilization Management Specialist

Humana, Inc.; Carson City (NV); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a UM Administration Coordinator to support utilization management operations from a remote position. The role handles provider/member calls, reviews prior authorizations, and performs back-office tasks to ensure timely processing.

Candidates should have 2+ years in customer service, handle high call volume, and be proficient with Microsoft Office. A wired internet connection and a quiet home workspace are required.

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)
• Preferred: customer service experience within healthcare, insurance, or health services.
• Experience with Utilization Review and Prior Authorization within a managed care organization
• Proficient using electronic medical record and documentation programs
• Knowledge of Medical Terminology and ICD-10 codes

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

Call handling

Typing proficiency

Tools

Microsoft Office

Job description

Humana, Inc. is seeking a UM Administration Coordinator to support utilization management operations from a remote position. The role handles provider/member calls, reviews prior authorizations, and performs back-office tasks to ensure timely processing.

Candidates should have 2+ years in customer service, handle high call volume, and be proficient with Microsoft Office. A wired internet connection and a quiet home workspace are required.