Utilization Management Administration Coordinator - Phone Intake

Descripción del puesto:

Become a part of our caring community

The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support to healthcare providers contacting the call center to initiate referral authorizations or check the status of existing requests. This role requires strong communication skills, attention to detail, and the ability to work efficiently in a fast-paced, high-volume environment. The Coordinator serves as a key liaison between providers and internal UM teams, ensuring timely and accurate processing of referral and authorization inquiries in accordance with organizational policies and regulatory guidelines.

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.
* Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests.
* Accurately gather, verify, and enter provider and member information into the appropriate systems.
* Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements.
* Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management.
* Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines.
* Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times.
* Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed.
* Maintain thorough documentation of all interactions and transactions in accordance with company standards.
* Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures.
* Adhere to all applicable privacy, confidentiality, and compliance regulations.

Use your skills to make an impact

Required Qualifications
* 1 or more years administrative or technical support experience
* Excellent verbal and written communication skills
* Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
* Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

* Proficient utilizing electronic medical record and documentation programs
* Proficient and/or experience with medical terminology and/or ICD-10 codes
* Bachelor's Degree in Business, Finance or a related field
* Prior member service or customer service telephone experience desired
* Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Additional Information

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours
40

Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.

About us

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana's Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
​
Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment