Utilization & Disease Management Administration Coordinator - Queue Management – Remote

CenterWell • Sodankylä, NV

21h • Remote

About The Position

Become a part of our caring community and help us put health first Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Conviva, a wholly owned subsidiary of Humana, Inc., we want to help people everywhere, including our team members, lead their best lives. We support our team members to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our team members fresh perspective, new insights, and exciting opportunities to enhance their careers. At Conviva, we’re seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry. The UM Administration Coordinator - Queue Management 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. The UM Administration Coordinator - Queue Management provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Decisions are typically focus on interpretation of area/department policy and methods 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. Focus: Referral/Authorization queue management. Process incoming Referrals /Authorizations based on the Humana Prior Auth List and Internal Processes. Assist clinical staff with requesting medical records by phone/fax/EMR. This role is and Remote opportunity only within the following states: TX, FL, KS, KY and NV Use your skills to make an impact

Requirements

• 1 or more years healthcare administrative or technical support experience
• Current or past HMO Experience
• Excellent verbal and written communication skills
• 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 (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Proficient utilizing electronic medical record and documentation programs
• Proficient and/or experience with medical terminology and/or ICD-10 codes
• Bachelor's Degree in Business, Finance or a related field
• Prior member service or customer service telephone experience desired
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Responsibilities

• Referral/Authorization queue management.
• Process incoming Referrals /Authorizations based on the Humana Prior Auth List and Internal Processes.
• Assist clinical staff with requesting medical records by phone/fax/EMR.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level