Utilization Management Administration Coordinator -- Home Health

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Full-Time, Remote Telephonic opportunity



The UM Administration Coordinator 2 supports the administration of utilization management by performing a variety of moderately complex administrative, operational, and customer service tasks.

Responsibilities may include significant telephonic interaction with providers, members, and other stakeholders, including receiving inbound calls, providing customer service, and supporting the intake of utilization management and prior authorization requests. Some associates may be assigned primarily or fully to telephonic responsibilities based on business needs.

Additional responsibilities may include creating and processing authorization cases, generating correspondence, triaging faxes and shared mailboxes, processing documentation, conducting calculations and data processing, and performing other administrative functions supporting utilization management. Specific work assignments may vary and may change over time based on business needs, volume, and operational priorities.

Assignments are generally semi-routine in nature.

The UM Administration Coordinator 2 provides non-clinical support for policies and procedures ensuring the best and most appropriate treatment, care, or services for members.

This role may serve as a key point of contact for providers and members through inbound telephonic interactions, including responding to questions and supporting the intake and processing of utilization management requests. Associates must be comfortable working in a phone-based customer service environment, and some assignments may require the majority or entirety of the workday to be dedicated to inbound calls. Other assignments may include building and updating authorization cases, creating letters and other correspondence, processing and routing faxes, triaging shared mailboxes, reviewing and routing documentation, and completing other non-clinical administrative activities supporting the utilization management process. Associates are expected to demonstrate flexibility as work assignments may change based on business needs and operational priorities. 

Decisions are typically focused on interpretation of area/department policy and process 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.

Success in this role requires the following:

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

• Strong customer service and verbal communication skills, including the ability to professionally manage a high volume of inbound telephone interactions.

• Comfort providing telephonic support while simultaneously navigating multiple systems, documenting interactions, and accurately processing information.

• Excellent organizational and time-management skills.

• Technical savvy and ability to navigate multiple systems and screens while working cases.

• Collaboration skills to effectively interact with multiple parties, both internal and external.

• Flexibility and adaptability to work across telephonic and non-telephonic utilization management functions and transition between assignments based on business needs.

• An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

• Ability to make decisions regarding your own work methods, occasionally in ambiguous situations and with minimal direction, receiving guidance where needed.

• Ability to follow established guidelines, processes, and procedures.

Use your skills to make an impact
 

Required Qualifications

• 1 or more years of administrative, technical support, customer service, or related experience 

• Excellent verbal and written communication skills 

• Ability and willingness to provide customer service and intake support through high-volume inbound telephone interactions; telephonic duties may comprise the primary assignment 

• Ability to simultaneously communicate by telephone, navigate multiple systems/screens, accurately document interactions, and process information 

• Working knowledge of MS Office, including Word, Excel, and Outlook in a Windows-based environment, and an ability to quickly learn new systems 

• Must have accessibility to high-speed DSL or cable modem for a home office 

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences 

• Ability to adapt to changing work assignments based on business and operational needs 

• Ability to work between the hours of 8 a.m. and 8 p.m. EST 

• Hours may include rotational weekend work

Preferred Qualifications

• Proficient utilizing electronic medical record and documentation programs 

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

• Bachelor's degree in Business, Finance, or a related field 

• Prior member, provider, call center, or customer service telephone experience 

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

Work-At-Home Requirements 

• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). 
• A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. 

• Check your internet speed at www.speedtest.net  

• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA 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 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 at Humana.com and at CenterWell.com.

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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.