Utilization Management Administration Coordinator

Profile

Job Information
Humana
Utilization Management Administration Coordinator
in
Charleston
West Virginia
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 **** 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 ****

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