Utilization Management Coordinator

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

📋 Description

• Manage inbound and outbound calls regarding prior authorizations, utilization management services, and benefits.

• Assist providers and members in navigating the utilization management processes.

• Review and process prior authorization requests and related documentation.

• Investigate and assess information that supports medical necessity decisions and authorization workflows.

• Conduct case research, update records, resolve errors, and ensure timely case processing.

• Verify, review, and accurately input information across various systems.

• Record interactions, research findings, and case activities in accordance with established protocols.

• Complete and oversee assigned work queues to achieve service level agreements and turnaround times.

• Collaborate with clinical and operational teams, as well as internal partners, to address issues and escalated concerns.

• Fulfill productivity, quality, service, and attendance standards.

• Adjust to changing priorities and support both phone and non-phone responsibilities.

• Participate in mandatory training during the first month, Monday through Friday from 8:00 AM to 4:30 PM CST.

• Receive cross-training across diverse lines of business and functions in utilization management.

⛳️ Requirements

• At least 2 years of experience in customer service.

• Proven experience managing a high volume of calls, approximately 30 to 50 daily, while engaging with callers and utilizing multiple computer systems.

• Typing speed of no less than 30 words per minute.

• Proficient in Microsoft Office applications.

• A direct wired connection to an internet router is required; Wi-Fi is not acceptable.

• A dedicated, professional workspace free from distractions, with a closed door.

• Capability to participate in meetings and training sessions using a webcam.

• Availability to work scheduled 8-hour shifts that conclude no later than 7:00 PM CST/8:00 PM EST, including one weekend day and a holiday rotation.

• Preferred experience in customer service within the healthcare, insurance, or health services sectors.

• Familiarity with Utilization Review and Prior Authorization in a managed care organization is a plus.

• Preferred proficiency in using electronic medical record and documentation systems.

• Knowledge of Medical Terminology and ICD-10 codes is advantageous.

• Exceptional attendance and reliability are essential.

• Maintain professionalism while working remotely.

• Comfortable appearing on camera when required.

• Ability to learn complex information through virtual training.

• Understanding of utilization management concepts, prior authorization procedures, and medical coding.

• Quick adaptability to learn new systems and respond to changing business needs.

• Minimum internet download speed of 25 Mbps and upload speed of 10 Mbps for self-provided internet service.

• Ability to work from a designated space without interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability benefits.

• Life insurance coverage.

• Cross-training opportunities to support various lines of business and utilization management functions.

• Remote work arrangement available.

• Occasional travel to Humana offices for training or meetings may be required.