Utilization Management Coordinator

Humana•Work at Home - Wisconsin, WI

1d•$40,000 - $52,300•Remote

About The Position

Humana is seeking a Utilization Management (UM) Coordinator to join its Wisconsin Medicaid Market (iCare) team. Reporting to the UMPA Administrative Supervisor, this role provides non-clinical support for policies and procedures intended to ensure members receive the best and most appropriate treatment, care, or services. The position supports providers and other stakeholders throughout the prior authorization process, including entering requests into the TruCare database and routing materials for clinical review. This is a remote home-workstyle role, with Humana office space used as needed for collaboration and other in-person needs. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. Central Time, with limited rotated holiday coverage availability. Occasional travel to Humana offices for training or meetings may be required. Home employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds, and a dedicated workspace that prevents ongoing interruptions and protects member PHI/HIPAA information.

Requirements

At least one year of experience working in a health care or health plan setting.
One to two years of experience using Microsoft Office applications, specifically Word, Excel, and PowerPoint.
At least one year of customer service experience involving inbound and outbound phone calls.
Availability to work Monday through Friday, 8:30 a.m. to 5:00 p.m. Central Time, with limited availability for rotated holiday coverage.
For home work, self-provided internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

One year of experience in prior authorization or utilization management.
One year of experience working in a health insurance environment.
Reside in the State of Wisconsin.

Responsibilities

Process and document incoming inpatient and outpatient prior authorization requests according to Humana policies and procedures.
Contact providers by phone or fax to request additional information or clarification as needed.
Conduct inbound and outbound calls.
Communicate with internal and external customers and providers about the status of prior authorization requests, including taking provider status calls.
Enter prior authorization requests into the TruCare database, prepare documentation, and assign tasks to the appropriate staff member for clinical review.
Manage multiple tasks throughout the day to meet the needs of multiple stakeholders.