Utilization Management Coordinator

Humana•Work at Home - Wisconsin, WI

2d•$40,000 - $52,300•Remote

About The Position

Humana is seeking a Utilization Management Coordinator to join the Wisconsin Medicaid Market (iCare) team. Reporting to the UMPA Administrative Supervisor, the coordinator provides non-clinical support for policies and procedures intended to ensure members receive the best and most appropriate treatment, care, or services. The role supports prior authorization processing and communication with providers and other stakeholders. This is a remote, home-workstyle position, with Humana office space used as needed for collaboration and face-to-face needs. The typical schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. Central Time, with limited availability for rotated holiday coverage. Occasional travel to Humana offices for training or meetings may be required. Employees must have a dedicated workspace that protects member PHI/HIPAA information and meet the stated home internet requirements: at least 25 Mbps download and 10 Mbps upload.

Requirements

One year of experience working in a health care setting or health plan setting.
One to two years of experience using Microsoft Office applications, specifically Word, Excel, and PowerPoint.
One year of customer service experience involving inbound and outbound phone calls.
Ability 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, and the employee must work from a dedicated space that protects 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 according to established processes.
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 route tasks to the appropriate staff member for clinical review.
Manage multiple tasks throughout the day to meet the needs of multiple stakeholders.