Utilization Management Coordinator

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Assist in the administration of Physical Health utilization management.

• Provide non-clinical assistance to Utilization Management Nurses and Physical Health Medical Directors.

• Process health service authorization requests.

• Interpret policies and procedures for the area and department to complete assignments.

• Identify work expectations and quality standards within set parameters.

• Prioritize and schedule tasks with some degree of independent judgment.

• Support members by ensuring appropriate treatment, care, and services.

• Safeguard member PHI/HIPAA information while working in a designated area.

• Occasionally travel to Humana offices for training or meetings as needed.

⛳️ Requirements

• A minimum of 1 year of administrative or technical support experience.

• Proficient in MS Office, including Word, Excel, and Outlook.

• Capable of working in a Windows-based environment.

• Ability to rapidly learn new systems.

• A strong desire to enhance consumer experiences through continuous improvement.

• Preference for proficiency in electronic medical record and documentation programs.

• Preferred familiarity with medical terminology and/or ICD-10 codes.

• A Bachelor's Degree in Business, Finance, or a related field is preferred.

• Desired experience in member service or customer service via telephone.

• Experience with Utilization Review and/or Prior Authorization, ideally within a managed care organization.

• Required home internet download speed of 25 Mbps and upload speed of 10 Mbps.

• Must have a dedicated workspace free from interruptions to protect member PHI/HIPAA information.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Competitive benefits promoting whole-person well-being.

• Personal wellness support.

• Home-based work arrangement.