Utilization Management Coordinator

About the role

Become a part of our caring community

Humana is seeking a Utilization Management (UM) Coordinator to join the Wisconsin Medicaid Market (iCare) team. Reporting to the UMPA Administrative Supervisor, you will provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. Join this dedicated team and lead change in how health care for the underserved in Wisconsin is managed.

• Process and document all incoming inpatient and outpatient prior authorization (PA) requests as outlined by Humana policies and procedures.
• Contact providers via phone or fax to request additional information or clarification as needed per established process.
• Conducts inbound and outbound calls.
• Work with customers/providers, both internally and externally, regarding the status of PA requests. Take phone calls from providers regarding status of PAs.
• Enter PA requests into the prior authorization database (TruCare), prepare documentation, and tasks to the appropriate staff member for clinical review.
• Multi- tasking consistently throughout the day to meet the needs of multiple stakeholders.

Required Qualifications

• One (1) year of experience working in a health care setting or health plan setting.
• 1-2 years of experience working in Microsoft Office software applications, specifically Word, Excel, and PowerPoint.
• 1 year of customer service experience with either inbound and outbound phone calls.
• Work the hours of 8:30-5pm CST, Monday through Friday. (Limited availability needed for rotated holiday coverage)

Preferred Qualifications

• 1 year of experience in prior authorization or utilization management.
• 1 year experience working in a health insurance environment.
• Reside in the State of WI

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Monday - Friday, 8:30 am - 5:00 pm Central Standard Time (CST)

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA 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

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.