Utilization Mgmt. Coordinator

Become a part of our caring community

At Humana, we work collaboratively to provide solutions and fulfill our commitment to serving members. The UM Administration Coordinator role supports UM operations through provider/member-facing phone support and back-office administrative responsibilities. As a UMAC 2, you will report to the Supervisor, UM Management, and support UM processes while working remotely.

Schedule: 8-hour shifts ending no later than 7:00pmCST/8:00 PM EST, including one weekend day (Saturday or Sunday) and holiday rotation. Scheduled breaks and meal periods are assigned to ensure adequate staffing and maintain service levels for providers and members.

Training Schedule

The first month consists of mandatory training conducted Monday through Friday from 8:00 AM to 4:30 PM CST

Key Responsibilities

As a Utilization Management Administration Coordinator, you will:

• Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits; help providers and members navigate these processes, with approximately 30 to 50 phone interactions daily when assigned to phone support.

• Process and review prior authorization requests and documentation, researching and evaluating information to support medical necessity determinations and authorization workflows.

• Perform back-office administrative tasks, including case research, record updates, error resolution, and timely case processing.

• Review, verify, and enter accurate information across multiple systems; document all interactions, research findings, and case activities while following established procedures, process flows, and work instructions.

• Complete and monitor assigned work queues to meet service level agreements and turnaround time requirements.

• Collaborate with clinical and operational teams and internal partners to resolve issues and address escalated concerns.

Performance Goals: Meet productivity, quality, service, and attendance expectations. Adapt to changing priorities and support both phone and non-phone responsibilities as operational needs evolve.

You will receive cross-training to support multiple lines of business and utilization management functions. Success in this role requires adaptability, strong organizational skills, attention to detail, and a commitment to delivering exceptional service to providers, members, and internal partners.

Use your skills to make an impact

Required Qualifications:

• Minimum of 2 years of customer service experience

• Experience managing a high-volume of calls (approximately 30 to 50 calls daily) using multiple computer systems while engaging callers

• Typing proficiency of at least 30 words per minute

• Proficient experience using Microsoft Office (including using toolbars, menus, and system features to locate documents)

• A direct wired connection to an internet router is required (Wi-Fi is not permitted)

• A dedicated, distraction-free, professional workspace with a closed door (ability to participate in meetings and training with a webcam)

Preferred Qualifications:

• Customer service experience within healthcare, insurance, or health services.

• Experience with Utilization Review and Prior Authorization within a managed care organization

• Proficient using electronic medical record and documentation programs

• Experience with Utilization Review and Prior Authorization

• Knowledge of Medical Terminology and ICD-10 codes

Successful candidates will demonstrate:

• Exceptional attendance and reliability.

• Professionalism while working remotely.

• A dedicated and distraction-free workspace.

• Comfort appearing on camera when required.

• Comfort learning complex information through virtual training

• Strong customer service experience, preferably in healthcare or insurance.

• Knowledge of utilization management concepts, prior authorization processes, and medical coding.

• Ability to learn new systems quickly and adapt to changing business needs.

Additional Information

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA 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 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 year

Description 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.