Utilization Management Coordinator

Humana; Wisconsin; Hybrid; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana is seeking a Utilization Management (UM) Coordinator for the Wisconsin Medicaid Market (iCare). You will provide non-clinical support to ensure appropriate care and services for members, reporting to the UMPA Administrative Supervisor.

Responsibilities include processing PA requests, contacting providers, updating the TruCare database, and coordinating with internal and external teams. Typical hours are 8:30–5:00 CST, with remote work and limited onsite collaboration as needed.

Qualifications

• 1 year of experience in a health care or health plan setting.
• 1–2 years of experience with Microsoft Office (Word, Excel, PowerPoint).
• 1 year of customer service experience with inbound and outbound calls.

Responsibilities

• Process and document inbound/outbound PA requests per Humana policies.
• Contact providers to obtain needed information for PA requests.
• Enter PA requests into TruCare and route for clinical review.
• Handle multiple tasks to support various stakeholders throughout the day.

Skills

Healthcare settings

MS Office (Word, Excel, PowerPoint)

Customer service (inbound/outbound)

TruCare PA system

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.

Use your skills to make an impact

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

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, 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 atHumana.comand atCenterWell.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 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.