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 administrative assistance within the department. This position is essential in managing the processes associated with utilization management, collaborating closely with leadership, Medical Directors, Nurses, and other team members.

Excel at Humana The Utilization Management Administrative Coordinator is responsible for delivering non-clinical support that aligns with policies and procedures to ensure the most effective treatment, care, or services for our members.

The Home Solutions Utilization Management Team is seeking a dedicated Administrative Coordinator who will assist in non-clinical functions that support the delivery of optimal treatment and services for members utilizing Home Health and Skilled Nursing Facility services. This role is integral to 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
  • Prepares and submits authorizations for evaluation
  • Handles inbound and outbound communications to confirm clinical information, discharge dates, and admission statuses throughout the day
  • Records call details and attaches received clinical information
  • Requests clinical documentation from providers and facilities
  • Composes and distributes written correspondence
  • Generates and sends determination letters
  • Collaborates with various roles, departments, providers, and team members

Benefits of Working at Humana

Humana offers a comprehensive benefits package that begins on your first day of employment, including:

  • Medical, Dental, and Vision Coverage
  • Health Savings and Flexible Spending Accounts
  • Life Insurance
  • 401(k) Retirement Plan
  • Paid Time Off, including holidays and personal days
  • Additional leave options for caregiving and parental responsibilities
  • And more

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 (proficient to advanced)
  • Experience in a metrics-driven environment

Preferred Qualifications

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

Additional Information

  • Remote position with flexible working hours available Monday to Friday between 8am and 8pm EST
  • Overtime may be required based on business needs
  • Weekend and holiday work may be necessary for this role

Work from Home Requirements

  • To ensure effective performance, associates working from home must have internet service that meets the following criteria:
  • A minimum download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications.
  • Wireless, Wired Cable, or DSL connections are preferred.
  • Satellite, cellular, and microwave connections may be used only if they provide an optimal connection and must be approved by leadership.
  • Humana will not reimburse associates for their internet service costs, except for those residing in specific states.
  • Humana will provide necessary telephone equipment to meet business requirements.
  • Associates must work from a dedicated space 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. This technology allows for interaction at a convenient time and location.

If selected to proceed, candidates may receive an invitation for a pre-recorded Voice, Text Messaging, and/or Video interview. The recorded interview will be reviewed to determine if the candidate will advance to the next round.

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 communities we serve. Through our insurance services and healthcare offerings, we strive to facilitate the best health outcomes for the millions of individuals we support.

Equal Opportunity Employer

Humana is committed to ensuring equal employment opportunities 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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