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The UM Administration Coordinator 2 contributes to the administration of utilization management. This role performs varied activities and moderately complex administrative, operational, and customer support assignments. It provides nonclinical support for policies and procedures ensuring the best and most appropriate treatment, care, or services for members.
Humana Healthy Horizons in Indiana is seeking Authorization Team Members to support the Utilization Management (UM) process by managing authorization requests, coordinating approvals, and ensuring compliance with policies and procedures.
This role is critical in supporting the UM team and care coordinators by handling authorization processing, allowing them to focus on direct member support. You will work closely with members, providers, internal UM staff, and care coordinators to ensure efficient and accurate processing of service authorizations.
Responsibilities Include (but Not Limited To)
- Accurately and efficiently process and enter authorization requests into the system.
- Review care team submitted service requests and validate required documentation before processing.
- Coordinate follow-up with the care team for missing or additional required information.
- Maintain detailed records of authorization approvals, denials, and modifications.
- Collaborate with UM nurses and care teams to escalate requests requiring additional clinical review.
- Monitor authorization timelines and turnaround times to prevent delays.
- Serve as a liaison between providers, members, and internal teams, ensuring smooth communication regarding service approvals.
- Identify potential discrepancies, errors, or inefficiencies and work proactively to resolve them.
- Assist with training and onboarding of new team members as needed.
Required Qualifications
- 1 or more years of administrative or technical support experience.
- Excellent verbal and written communication skills.
- Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems.
- Must have accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Preferred Qualifications
- Proficient utilizing electronic medical record and documentation programs.
- Proficient and/or experience with medical terminology and/or ICD-10 codes.
- Bachelor's Degree in Business, Finance, or a related field.
- Prior member service or customer service telephone experience desired.
- Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization.
Additional 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: $40,000 - $52,300 per year. The pay range may be higher or lower based on geographic location and individual pay will vary based on skills, experience, and education.
Description Of Benefits
Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave, short-term and long-term disability, and life insurance.
About Us
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.
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.