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The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

As a UM Coordinator you will be responsible for taking prior authorization requests from providers and members. Because of this we are a fast-paced metric driven call center environment where you are sitting at a desk all day taking about 30-50 calls from providers. In the future this could lead to opportunities assisting on member calls.

You will assist providers with determining whether the service they will be providing to a member requires authorization or referral. If a member needs a medical service, their provider will call us to start the authorization process to determine if it meets medical necessity for that service. The purpose is to ensure providers are not requesting unnecessary services for members, which lead to out-of-pocket expenses for those members. You may also be assisting providers with updates or questions on those authorizations/referrals.

The authorization process starts with our team. You may also assist our members with authorization requests, and this may require outbound calls to providers offices. As a UM coordinator you will be collecting clinical information and reviewing resources and data to determine positive outcomes for our consumers. You will be challenged on a daily basis as our processes and procedures tend to change due to CMS rules and regulations. Taking pride in your work will be key as we have strong quality requirements that need to be met on a monthly basis. Our mission is health teammates healthy company and health customers. We focus on living out our values on a daily basis by creating an environment where you feel valued, respected and treated with kindness. We work and learn together creating the best solutions for the people we serve. We are committed to fulfilling our purpose by delivering on our commitments to serve our customers with excellence.

This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital.

In this role you will:

• Take inbound calls to engage members and/or providers to verify clinical information

• Handle customer inquiries both telephonically and by fax

• Learn how to maneuver our process flow to effectively handle customer requests

• Provide excellence customer service to our customers

• Document all call information according to standard operating procedures and attach clinical information when necessary

• Use multiple systems, therefore the ability to maneuver multiple systems at one time is vital.

• Identify and escalate issues

• Thrives in a fast-paced environment where their day is planned and structured

• Would thrive living out our values daily (Curious, Committed, Caring)

• Ability to work with minimal supervision, take initiative, have strong analytical skills, and strong attention to detail

• Must be able to navigate process flows and follow procedure documents

• Able to retain important information and learn virtually

Use your skills to make an impact

Required Qualifications

• 1 year or greater of administrative, technical support or customer service experience

• Excellent verbal and written communication skills

• Ability to effectively de-escalate challenging situations during calls

• Capacity to multitask across various computer systems while engaging with providers

• Quick aptitude for learning and navigating new technology systems and applications

• Proficiency in Microsoft Office applications, including Word and Excel

• Proficient keyboarding skills for data entry and documentation

• A designated workspace that minimizes distractions and meets leadership approval

• Must effectively manage personal responsibilities to ensure a professional work environment conducive to achieving performance goals

• Availability to work any shift between 7 AM and 7 PM CST. After the training and adjustment phase, the permanent shift will be 10:30 AM to 7 PM CST

Work-At-Home Requirements:

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

• Satellite and Wireless Internet service is NOT allowed for this role.

• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Proficient utilizing electronic medical record and documentation programs

• Proficient and/or experience with medical terminology and/or ICD-10 codes

• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

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.

$37,200 - $51,200 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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.