Utilization & Disease Management Administration Coordinator - Queue Management – Remote

Summary: Conviva Senior Primary Care is a subsidiary of Humana, Inc. focused on enhancing the health and well-being of individuals. The UM Administration Coordinator - Queue Management is responsible for the administration of utilization management, providing non-clinical support for policies and procedures, and managing referral and authorization processes. Responsibilities: - Contributes to administration of utilization management - Performs varied activities and moderately complex administrative/operational/customer support assignments - Performs computations - Typically works on semi-routine assignments - Provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members - Makes decisions typically focused on interpretation of area/department policy and methods for completing assignments - Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction - Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion - Focus: Referral/Authorization queue management - Processes incoming Referrals /Authorizations based on the Humana Prior Auth List and Internal Processes - Assists clinical staff with requesting medical records by phone/fax/EMR Required Qualifications: - 1 or more years healthcare administrative or technical support experience - Current or past HMO 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 Required Skills: Healthcare administrative experience, HMO experience, Electronic medical records Important Skills: ICD-10 codes, MS Office proficiency Nice-to-Have Skills: Customer service experience, Utilization Review experience, Verbal communication, Written communication Benefits: Medical, dental and vision benefits, 401(k) retirement savings plan, Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), Short-term and long-term disability, Life insurance