Utilization Management Administrative Specialist

2 weeks ago


Charleston, West Virginia, United States Humana Full time

Contribute to a Health-First Approach

The Utilization Management Administrative Coordinator plays a vital role in providing essential clerical assistance within the department. This position serves as a key player in the processes related to utilization management, collaborating closely with leadership, Medical Directors, Nurses, and other team members.

Excel in Your Role at Humana The Administrative Coordinator is responsible for non-clinical support related to policies and procedures that ensure optimal treatment, care, or services for members.

The Home Solutions Utilization Management Team is seeking an Administrative Coordinator to offer non-clinical assistance for policies and procedures, ensuring the best and most suitable treatment and services for members utilizing Home Health and Skilled Nursing Facility services. This team operates within the Home Solutions organization and contributes to the Value-Based segment in partnership with CenterWell and Onehome.

  • Oversees NLP's for nursing team chart reviews
  • Develops and manages authorizations for review
  • Handles inbound and outbound communications to engage providers and members for clinical information verification
  • Records calls and attaches received clinical information
  • Requests clinical data from providers and facilities
  • Generates and dispatches written correspondence
  • Creates and distributes determination letters
  • Collaborates across various roles, departments, and team members

Important Reminder: Please attach your resume

Humana is not only a great workplace but also offers industry-leading benefits starting from your first day of employment. Benefits include:

  • Comprehensive Medical Coverage
  • Dental and Vision Insurance
  • Health Savings Accounts
  • Flexible Spending Accounts
  • Life Insurance
  • 401(k) Retirement Plan
  • Paid Time Off including holidays, personal days, volunteer time, and parental leave
  • And more

Utilize Your Skills for a Meaningful Impact

Required Qualifications

  • Minimum of 1 year of experience in an administrative support role within the healthcare sector
  • Proficient in Microsoft Word, Outlook, and Excel with accurate data entry skills
  • Ability to quickly adapt to new systems
  • Experience in a metrics-driven environment

Preferred Qualifications

  • Experience with CGX, SRO, and HCHB
  • Familiarity with Utilization Review and/or Prior Authorization, ideally in a managed care setting
  • Proficient in electronic medical record systems
  • Knowledge of medical terminology and ICD-10 codes
  • Experience with Skilled Nursing Facilities and/or Home Health

Additional Information

  • Remote position with flexible working hours Monday to Friday
  • Overtime may be available based on business needs
  • Weekend and holiday work may be required

Work from Home Requirements

  • Self-provided internet service must meet minimum download speed of 25 Mbps and upload speed of 10 Mbps
  • Wireless, Wired Cable, or DSL connections are recommended
  • Dedicated workspace free from interruptions to protect member PHI/HIPAA information

Our Hiring Process

As part of our hiring process, candidates may be contacted via text message and email for further information using a platform called HireVue. Candidates selected for the next steps may be invited to participate in a pre-recorded interview.

Scheduled Weekly Hours

40

Compensation Range

The compensation range reflects a good faith estimate of starting base pay for full-time employment. The pay range may vary based on geographic location and individual qualifications, with a range of $37,200 - $51,200 per year.

About Humana

Humana Inc. is dedicated to prioritizing health for our teammates, customers, and the community. Through our insurance and healthcare services, we strive to facilitate better health outcomes for the millions we serve.

Equal Opportunity Employer

Humana is committed to a policy of equal employment opportunity and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status.



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