Utilization Management Coordinator

Humana Inc; Atlanta (GA); Remote; USD 40,000 - 53,000; Full time

Job summary

A leading company in health services is seeking a UM Administration Coordinator to support the Kentucky Medicaid plan by performing administrative tasks and ensuring effective service delivery to members. This remote role requires strong skills in customer service and communication, with a focus on utilizing MS Office tools efficiently. Join this team to contribute to impactful healthcare solutions while enjoying the flexibility of a work-from-home environment.

Qualifications

• Minimum 1 year administrative, customer service, or technical support experience required.
• Self-motivated with strong communication skills.
• Working knowledge of electronic medical records and documentation programs preferred.

Responsibilities

• Perform varied activities and moderately complex administrative tasks.
• Support policies ensuring appropriate treatment and care for members.
• Work within defined parameters and prioritize tasks.

Skills

Communication

Self-discipline

Customer service

Education

Some college or higher education

Tools

MS Office

Job description

Job Profile

UM Administration Coordinator 2

Job Level

Representative 2

Become a part of our caring community and help us put health first

The UM Administration Coordinator contributes to administration of utilization management for Humana’s KY Medicaid plan. 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 UM Administration Coordinator provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.

Role Overview:

• Decisions are typically focused on interpretation of area/department policy and methods for completing assignments.
• 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.
• Performs varied activities and moderately complex administrative/operational/customer support assignments.

Use your skills to make an impact

Required Qualifications

• Minimum 1 year administrative, customer service, patient care or technical support experience in an office type environment.
• Excellent verbal and written communication skills.
• The ideal candidate should be self-motivated and exhibit a strong sense of self-discipline
• Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems.
• Location:Must reside and perform work in Kentucky
• Travel: 1 time quarterly/4 times annually
• Training: 6-week training process
• Workstyle: Remote work at home.
• Schedule: Monday through Friday 9:00 AM – 6:00 PM Eastern Time and ability to work on the weekends to support business needs.

Preferred Qualifications

• Some college or higher education.
• Proficient utilizing electronic medical record and documentation programs.
• Proficient and/or experience with medical terminology and/or ICD-10 codes.
• Prior member service or customer service, telephone experience
• Experience with Utilization Review and/or Prior Authorization. preferably within a managed care organization.

Additional Information

Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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 required.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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 Process

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.

SSN Alert Humana values your personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

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

Referral Bonus Information

This requisition is not eligible for a referral bonus.

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.