UM Administration Coordinator 2

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

Job summary

An established industry player is seeking a dedicated UM Administration Coordinator to enhance their Utilization Management team. This role is pivotal in processing authorization requests, ensuring compliance, and collaborating with care coordinators to provide seamless service to members. The ideal candidate will bring a blend of healthcare experience and strong communication skills, thriving in a fast-paced environment. Join a caring community focused on health and well-being, where your contributions will directly impact the lives of many. If you are passionate about making a difference in healthcare, this opportunity is for you.

Benefits

Medical, Dental and Vision Benefits

401(k) Retirement Savings Plan

Paid Time Off

Short-term and Long-term Disability

Life Insurance

Qualifications

• 1 year of experience in care management or care coordination.
• Strong critical thinking and problem-solving skills.

Responsibilities

• Process and enter authorization requests accurately.
• Coordinate follow-up with care teams for missing information.
• Serve as a liaison between providers and members.

Skills

Care Management

Problem-Solving

Critical Thinking

Communication

Attention to Detail

Education

Associates Degree in Healthcare

Job description

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.

Responsibilities include (but not limited to):

• 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.

Use your skills to make an impact

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 at Home Criteria

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.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• 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.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many 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 make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to 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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.