Utilization Management Coordinator

Humana; United States; Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short/long-term disability

Life insurance

Job summary

Humana is seeking a Utilization Management (UM) Coordinator to support the Wisconsin Medicaid iCare team. You will process prior authorization requests, enter data into the TruCare system, and communicate with providers to obtain necessary information.

This remote role follows CST business hours with occasional travel for training. The ideal candidate will have healthcare or health plan experience, proficiency in Microsoft Office, and strong customer-service skills to support multiple

Qualifications

• 1 year of experience in a health care or health plan setting.
• 1–2 years of experience using Microsoft Word, Excel, and PowerPoint.
• 1 year of customer service experience handling inbound/outbound calls.

Responsibilities

• Process and document all incoming PA requests per Humana policies.
• Contact providers by phone or fax for additional information as needed.
• Handle inbound and outbound calls; communicate PA status to customers/providers.

Skills

Healthcare setting experience

Microsoft Office

Customer service

Tools

TruCare

Job description

Become a part of our caring community

Humana is seeking a Utilization Management (UM) Coordinator to join the Wisconsin Medicaid Market (iCare) team. Reporting to the UMPA Administrative Supervisor, you will provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Join this dedicated team and lead change in how health care for the underserved in Wisconsin is managed.

Process and document all incoming inpatient and outpatient prior authorization (PA) requests as outlined by Humana policies and procedures.

Contact providers via phone or fax to request additional information or clarification as needed per established process.

Conducts inbound and outbound calls.

Work with customers/providers, both internally and externally, regarding the status of PA requests. Take phone calls from providers regarding status of PAs.

Enter PA requests into the prior authorization database (TruCare), prepare documentation, and tasks to the appropriate staff member for clinical review.

Multi- tasking consistently throughout the day to meet the needs of multiple stakeholders.

Required Qualifications

• One (1) year of experience working in a health care setting or health plan setting.
• 1-2 years of experience working in Microsoft Office software applications, specifically Word, Excel, and PowerPoint.
• 1 year of customer service experience with either inbound and outbound phone calls.
• Work the hours of 8:30-5pm CST, Monday through Friday. (Limited availability needed for rotated holiday coverage)

Preferred Qualifications

• 1 year of experience in prior authorization or utilization management.
• 1 year experience working in a health insurance environment.
• Reside in the State of WI

Additional Information

Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

Typical Work Days/Hours: Monday - Friday, 8:30 am - 5:00 pm Central Standard Time (CST)

Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• and many other opportunities

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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