Utilization Management Administration Coordinator

Profile

Job Information

Humana

Utilization Management Administration Coordinator

in

Pittsburgh

Pennsylvania

Description

The UM Administration Coordinator 2 contributes to administration of utilization management.

How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Responsibilities

The newly formed Home Solutions UM/NM Team is hiring for a UM Administration Coordinator 2 that will provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members utilizing home health services. This team sits in the Home Solutions organization and contributes to the Value-Based segment partnering with Kindred At Home/CenterWell and onehome.

The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.

Key Responsibilities:

Attaching faxes for chart reviews for the nursing and medical team

Answering departmental phones as assigned

Make outbound calls to engage members and/or providers to verify clinical information/discharge date and admission status

Document calls and attach clinical information received

Request clinical information from providers/facilities

Create and send out written correspondence

Ability to multitask and prioritize

Collaborate with multiple roles/departments/providers/team members

Required Qualifications

1 or more years of Administrative support, Healthcare or telephonic Customer Service experience

Excellent verbal and written communication skills

Working knowledge of MS Office Word and Excel in a Windows based environment and an ability to quickly learn new systems

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

CGX experience with building cases and generating letters

Proficient utilizing electronic medical record and documentation programs

Proficient and/or experience with medical terminology and/or ICD-10 codes

Prior member service or customer service telephone experience desired

Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Microsoft Outlook

Additional Information

Remote position with possibility of flexible working hours Monday to Friday between 8am and 5pm EST (8 paid hours per business day)

Overtime available based upon business needs

Weekend and/or holiday on call coverage required for this role on a volunteer basis

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com