Utilization Management Administration Coordinator - SNF

Humana

9d • Remote

About The Position

Become a part of our caring community The UM Administration Coordinator (UMAC) provides non-clinical support for policies ensuring the most appropriate treatment, care or services for members using services. Reporting to the Manager of Utilization Management, you will work fully remote. You are part of the Home Solutions organization, which contributes to the Skilled Nursing Facility segment. This segment partners with CenterWell and Onehome. As a Utilization Management Administration Coordinator, you will work within defined parameters to meet work expectations and quality standards. You will manage NLP's for chart reviews for the nursing team You will build and pend authorizations for review You will perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day and will document completed calls and attach clinical information received. You will request clinical information from providers/facilities You will create written correspondence You will create and distribute determination letters And you will collaborate with multiple roles/departments/providers/team members Use your skills to make an impact

Requirements

• 1+ years' experience working in an administrative support capacity
• Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data
• Ability to new systems (proficient to advanced)

Nice To Haves

• Experience with Utilization Review or Prior Authorization within a managed care organization
• Proficient using electronic medical record and documentation programs
• Experience with medical terminology or ICD-10 codes
• Prior member service or customer service telephone experience
• Experience with SNF or Home Health
• Prior experience with CGX, SRO and HCHB
• Prior experience in a metric driven environment
• Prior experience in the healthcare industry

Responsibilities

• Manage NLP's for chart reviews for the nursing team
• Build and pend authorizations for review
• Perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day and will document completed calls and attach clinical information received.
• Request clinical information from providers/facilities
• Create written correspondence
• Create and distribute determination letters
• Collaborate with multiple roles/departments/providers/team members

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
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees