Utilization Mgmt. Coordinator

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

Benefits offered by this job

Remote work

Training & development

Competitive benefits

Job summary

Humana Inc. is seeking an UM Administration Coordinator to support UM operations through provider and member phone support and back-office administrative duties.

This remote role reports to the Supervisor, UM Management and requires 8-hour shifts ending by 7:00 PM CST/8:00 PM EST, with one weekend day and holiday rotation. You will handle prior authorizations, utilization management tasks, manage high call volumes, perform case research, data entry, and coordinate with clinical and operational

Qualifications

• Minimum of 2 years of customer service experience.
• Experience managing a high-volume of calls (approximately 30 to 50 daily) using multiple computer systems while engaging callers.
• Typing proficiency of at least 30 words per minute.
• Proficient experience using Microsoft Office (including toolbars, menus, and system features to locate documents).
• Direct wired internet connection required (Wi-Fi not permitted).
• Dedicated, distraction‑free workspace with webcam for meetings and training.

Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; ~30–50 calls daily.
• Process and review prior authorization requests and documentation; support medical necessity determinations.
• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely processing.
• Review, verify, and enter information across systems; document interactions and case activities.
• Complete and monitor work queues to meet service levels and turnaround times.
• Collaborate with clinical and operational teams to resolve issues and address escalations.

Skills

Customer service

Phone support

Typing 30 wpm

MS Office

Wired internet

Remote workspace

Job description

Become a part of our caring community At Humana, we work collaboratively to provide solutions and fulfill our commitment to serving members.

The UM Administration Coordinator role supports UM operations through provider/member-facing phone support and back-office administrative responsibilities.

As a UMAC 2, you will report to the Supervisor, UM Management, and support UM processes while working remotely.

Schedule: 8-hour shifts ending no later than 7:00pmCST/8:00 PM EST, including one weekend day (Saturday or Sunday) and holiday rotation. Scheduled breaks and meal periods are assigned to ensure adequate staffing and maintain service levels for providers and members.

Training Schedule: The first month consists of mandatory training conducted Monday through Friday from 8:00 AM to 4:30 PM CST.

Key Responsibilities

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; help providers and members navigate these processes, with approximately 30 to 50 phone interactions daily when assigned to phone support.
• Process and review prior authorization requests and documentation, researching and evaluating information to support medical necessity determinations and authorization workflows.
• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely case processing.
• Review, verify, and enter accurate information across multiple systems; document all interactions, research findings, and case activities while following established procedures, process flows, and work instructions.
• Complete and monitor assigned work queues to meet service level agreements and turnaround time requirements.
• Collaborate with clinical and operational teams and internal partners to resolve issues and address escalated concerns.

Performance Goals

• Meet productivity, quality, service, and attendance expectations.
• Adapt to changing priorities and support both phone and non-phone responsibilities as operational needs evolve.

Required Qualifications

• Minimum of 2 years of customer service experience
• Experience managing a high-volume of calls (approximately 30 to 50 calls daily) using multiple computer systems while engaging callers
• Typing proficiency of at least 30 words per minute
• Proficient experience using Microsoft Office (including using toolbars, menus, and system features to locate documents)
• A direct wired connection to an internet router is required (Wi-Fi is not permitted)
• A dedicated, distraction‑free, professional workspace with a closed door (ability to participate in meetings and training with a webcam)

Preferred Qualifications

• Customer service experience within healthcare, insurance, or health services.
• Experience with Utilization Review and Prior Authorization within a managed care organization
• Proficient using electronic medical record and documentation programs
• Experience with Utilization Review and Prior Authorization Knowledge of Medical Terminology and ICD-10 codes

Successful candidates will demonstrate

• Exceptional attendance and reliability.
• Professionalism while working remotely.
• A dedicated and distraction‑free workspace.
• Comfort appearing on camera when required.
• Comfort learning complex information through virtual training
• Strong customer service experience, preferably in healthcare or insurance.
• Knowledge of utilization management concepts, prior authorization processes, and medical coding.
• Ability to learn new systems quickly and adapt to changing business needs.

Additional Information

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 25Mbps and an upload speed of 10Mbps 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

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 to achieve the best health. 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 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.