UM Administration Coordinator

Humana; Indiana (PA); Remote; USD 40,000 - 53,000; Full time

Job summary

A leading healthcare company in Indiana is looking for a UM Administration Coordinator 2 to manage authorization requests and support the Utilization Management process. This role involves critical communication with members and providers to ensure timely processing of service authorizations. Candidates should have experience in care coordination and critical thinking skills. The position offers a flexible work environment, with occasional onsite requirements.

Benefits

Medical, dental, and vision benefits

401(k) retirement plan

Paid time off

Disability and life insurance

Qualifications

• 1 year of experience in care management or care coordination.
• Minimum of 2 years healthcare-related experience.
• Experience working with diverse populations and managing sensitive healthcare information.

Responsibilities

• Accurately process and enter authorization requests.
• Collaborate with UM nurses and care teams to facilitate requests.
• Maintain detailed records of authorization approvals and denials.

Skills

Critical thinking

Problem-solving

Effective communication

Attention to detail

Education

Associates Degree in a healthcare-related field

Job description

Overview

Become a part of our caring community and help us put health first. The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The role provides nonclinical support for the policies and procedures ensuring the best and most appropriate treatment, care or services for members. Decisions typically focus on interpretation of area/department policy and methods for completing assignments. Humana Healthy Horizons in Indiana is seeking Authorization Team Members to support the Utilization Management (UM) Process by managing authorization requests, coordinating approvals, and ensuring compliance with policies and procedures. The UM Administration Coordinator 2 role is critical in supporting the UM team and care coordinators by handling authorization processing, allowing them to focus on direct member support. The Authorization Team Member will work closely with members, providers, internal UM staff, and care coordinators to ensure efficient and accurate processing of service authorizations. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Note: This description reflects the responsibilities and requirements of the position as posted.

Responsibilities

• Accurately and efficiently process and enter authorization requests into the system.
• Review care team submitted service requests and validate required documentation before processing.
• Coordinate follow-up with the care team for missing or additional required information.
• Maintain detailed records of authorization approvals, denials, and modifications.
• Collaborate with UM nurses and care teams to escalate requests requiring additional clinical review.
• Monitor authorization timelines and turnaround times to prevent delays.
• Serve as a liaison between providers, members, and internal teams, ensuring smooth communication regarding service approvals.
• Identify potential discrepancies, errors, or inefficiencies and work proactively to resolve them.
• Assist with training and onboarding of new team members as needed.

Required Qualifications

• Must reside in the state of Indiana.
• 1 year of experience in care management or care coordination, LTSS or Utilization Management authorization processes within managed care
• Minimum of 2 years healthcare-related experience
• Strong critical thinking and problem-solving skills to assess documentation and identify discrepancies.
• Ability to communicate professionally and effectively with providers, members, and internal stakeholders.
• Attention to detail with the ability to follow structured workflows and ensure compliance.
• Experience working with diverse populations and managing sensitive healthcare information.
• Ability to work independently and collaboratively within a fast-paced environment

Preferred Qualifications

• Associates Degree in a healthcare-related field
• Experience working in Managed Care Organizations (MCOs), Medicaid, or Medicare.
• Familiarity with CMS regulations, HCBS waivers, and LTSS services.
• 1+ years of experience working with vulnerable populations and the assessment and provision of LTSS services.
• Experience in medical authorizations, prior authorizations, or UM processes

Additional Information

• Workstyle: Remote but may vary due to occasional onsite work at the Humana Healthy Horizons office in Indiana.
• Travel: Up to 10% travel in the state of Indiana to Humana locations.
• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern

Work from Home Guidance

• To Ensure Home Or Hybrid Home/Office Associates’ Ability To Work Effectively, The Self-provided Internet Service Of Home Or Hybrid Home/Office Associates Must Meet The Following Criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Role and Compliance

This role is part of Humana's Driver Safety program and requires a valid state driver\'s license, proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits, and access to a reliable vehicle. It is considered patient facing and is part of Humana at Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Interview Process

As part of our hiring process, we will use Modern Hire screening technology. You will respond via text, video, or voice technologies. If selected for a screen, you may receive an email invitation to participate. The screen is expected to take about 15 to 30 minutes, and your response will be reviewed to determine next steps. Travel to Humana offices for training or meetings may be required occasionally.

Compensation and Benefits

Scheduled Weekly Hours: 40

Pay Range: $40,000 - $52,300 per year (base pay, 40 hours/week). The actual base pay may vary by location and experience.

Description Of Benefits: Humana offers medical, dental, and vision benefits, 401(k) retirement plan, paid time off, holidays, volunteer time off, parental and caregiver leave, disability and life insurance, and other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we deliver care and service when needed, serving Medicare, Medicaid, families, individuals, and communities.

Equal Opportunity Employer

Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana also takes affirmative action to employ and advance individuals with disability or protected veteran status, in compliance with applicable laws.