Utilization Management Administration Coordinator… at Humana · Remote

Summary: Humana Inc. is a leading U.S. healthcare company, and they are seeking a Utilization Management Administration Coordinator to provide non-clinical support for policies ensuring appropriate treatment and care for members. The role involves managing authorizations, coordinating with providers, and documenting critical information, all while working remotely.

Responsibilities:
- You will manage NLP's for chart reviews for the nursing team
- You will build and pend authorizations for review
- You will perform inbound and outbound calls to engage providers and members to verify clinical information/discharge date and admission status throughout the day and will document completed calls and attach clinical information received
- You will request clinical information from providers/facilities
- You will create written correspondence
- You will create and distribute determination letters
- And you will collaborate with multiple roles/departments/providers/team members

Required Qualifications:
- 1+ years' experience working in an administrative support capacity
- Prior professional experience of Microsoft Word, Outlook and Excel with the ability to type and enter data
- Ability to new systems (proficient to advanced)

Preferred Qualifications:
- Experience with Utilization Review or Prior Authorization within a managed care organization
- Proficient using electronic medical record and documentation programs
- Experience with medical terminology or ICD-10 codes
- Prior member service or customer service telephone experience
- Experience with SNF or Home Health
- Prior experience with CGX, SRO and HCHB
- Prior experience in a metric driven environment
- Prior experience in the healthcare industry

Required Skills: Microsoft Word, Microsoft Outlook, Microsoft Excel, Electronic Medical Record Systems, Medical Terminology, ICD-10 Codes, Utilization Review, Prior Authorization, Data Entry, CGX, SRO, HCHB

Benefits: Medical, dental and vision benefits, 401(k) retirement savings plan, Time off (including paid time off, company and personal holidays, paid parental and caregiver leave), Short-term and long-term disability, Life insurance and many other opportunities