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Utilization Management Administration Coordinator II , non-clinical, supports the UM operations by performing administrative and clerical tasks, rather than clinical duties. This role focuses on the administrative aspects of managing healthcare utilization, ensuring efficient and effective processes within the UM program. Key Responsibilities of a Non-Clinical UM Coordinator:
Intake and Notification:
Handling initial requests for services, gathering necessary information, and communicating with relevant parties.Prior Authorization Support:
Assisting with the prior authorization process by gathering information, preparing documentation, and tracking requests.Document Management:
Maintaining and organizing patient records, ensuring accurate and up-to-date information is available for reviews.Communication:
Facilitating communication between healthcare providers, patients, and other stakeholders regarding UM processes.Data Entry and Reporting:
Accurately entering data into systems, generating reports, and tracking key performance indicators related to UM activities.Letter Management:
Managing the generation and distribution of various letters related to UM decisions and processes.General Administrative Support:
Providing general administrative support to the UM team, including scheduling meetings, managing calendars, and preparing presentations.
In essence, the non-clinical UM Coordinator acts as a vital link in the UM process, ensuring smooth workflows and effective communication while handling the administrative side of utilization management.
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
40Pay Range
The 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 yearDescription of Benefits
Humana, 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 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 creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
