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Utilization Management Coordinator

2 months ago

Baton Rouge, Louisiana, United States Humana Full time
Job Summary

We are seeking a skilled Utilization Management Coordinator to join our team at Humana. As a key member of our Wisconsin Medicaid Market team, you will play a critical role in ensuring the best and most appropriate treatment, care, or services for our members.

Key Responsibilities
  • Process and document all incoming inpatient and outpatient prior authorization requests in accordance with Humana policies and procedures.
  • Communicate effectively with customers/providers, both internally and externally, regarding the status of prior authorization requests.
  • Enter prior authorization requests into the prior authorization database (TruCare), prepare documentation, and tasks to the appropriate staff member for clinical review.
Requirements
  • One (1) year of experience working in a healthcare setting.
  • Experience working in Microsoft Office software applications, specifically Word, Excel, and PowerPoint.
  • One (1) year of customer service experience answering phone calls.
  • Experience with and knowledge of ICD-10, HCPCS, and CPT codes.
Preferred Qualifications
  • Experience in prior authorization or utilization management.
  • Experience working in a health insurance environment or managed care setting.
  • Medical Assistant experience.
Work Environment

This is a remote nationwide position with a workstyle defined as home. You will use Humana office space on an as-needed basis for collaboration and other face-to-face needs.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. These benefits include health benefits effective day one, paid time off, holidays, volunteer time, and jury duty pay, recognition pay, 401(k) retirement savings plan with employer match, tuition assistance, scholarships for eligible dependents, parental and caregiver leave, employee charity matching program, network resource groups, and career development opportunities.