Utilization Management Coordinator

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

📋 Description

• Process and document incoming inpatient and outpatient prior authorization requests in accordance with Humana's policies and procedures.

• Reach out to providers via phone or fax to obtain additional information or clarification.

• Handle both inbound and outbound calls.

• Collaborate with internal and external customers/providers regarding the status of prior authorization requests.

• Address provider inquiries concerning prior authorization status.

• Input prior authorization requests into the TruCare database.

• Prepare necessary documentation and delegate tasks to the appropriate staff for clinical review.

• Manage multiple tasks throughout the day to fulfill the requirements of various stakeholders.

⛳️ Requirements

• A minimum of one (1) year of experience in a healthcare or health plan environment.

• 1-2 years of experience using Microsoft Office applications, particularly Word, Excel, and PowerPoint.

• At least one year of customer service experience involving inbound and outbound phone communications.

• Capability to work from 8:30 am to 5:00 pm CST, Monday through Friday, with limited availability for holiday coverage on a rotating basis.

• Must reside in the State of Wisconsin.

• Ability to work from a designated area free from continuous interruptions to safeguard member PHI / HIPAA information.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• Preferred: One year of experience in prior authorization or utilization management.

• Preferred: One year of experience in a health insurance setting.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work options.

• Occasional access to Humana office space for collaboration and in-person meetings.

• Support for internet service requirements for home or hybrid employees.

• Dedicated workspace to ensure the protection of member PHI / HIPAA information.

• Opportunities for training and meetings.

• Occasional travel to Humana offices for training or meetings.