Utilization Management Coordinator

🔥 33 minutes ago

🇺🇸 United States – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits • Help providers and members navigate utilization management processes • Process and review prior authorization requests and documentation • Research and evaluate information supporting medical necessity determinations and authorization workflows • Perform case research, record updates, error resolution, and timely case processing • Review, verify, and enter accurate information across multiple systems • Document interactions, research findings, and case activities according to established procedures • Complete and monitor assigned work queues to meet service level agreements and turnaround requirements • Collaborate with clinical and operational teams and internal partners to resolve issues and escalated concerns • Meet productivity, quality, service, and attendance expectations • Adapt to changing priorities and support phone and non-phone responsibilities • Complete mandatory first-month training Monday through Friday from 8:00 AM to 4:30 PM CST • Receive cross-training across multiple lines of business and utilization management functions

🎯 Requirements

• 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 • Direct wired connection to an internet router; Wi-Fi is not permitted • Dedicated, distraction-free, professional workspace with a closed door • Ability to participate in meetings and training with a webcam • Ability to work scheduled 8-hour shifts ending no later than 7:00 PM CST/8:00 PM EST, including one weekend day and holiday rotation • Customer service experience within healthcare, insurance, or health services preferred • Experience with Utilization Review and Prior Authorization within a managed care organization preferred • Proficiency using electronic medical record and documentation programs preferred • Knowledge of Medical Terminology and ICD-10 codes preferred • Exceptional attendance and reliability • Professionalism while working remotely • Comfort appearing on camera when required • Comfort learning complex information through virtual training • Knowledge of utilization management concepts, prior authorization processes, and medical coding • Ability to learn new systems quickly and adapt to changing business needs • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for self-provided internet service • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Cross-training to support multiple lines of business and utilization management functions • Remote work arrangement • Potential occasional travel to Humana offices for training or meetings