Become a part of our caring community and help us put health first

In the role of UM Coordinator 2, you will join our dynamic Clinical Call Center team, engaging daily with both providers and members while managing approximately 30 to 50 calls per day. Your responsibilities will include assisting providers in determining whether a member’s service requires prior authorization or a referral, responding to inquiries about authorization statuses, and gathering clinical information for pending authorizations. You may also support members with their authorization requests, which could involve making outbound calls to provider offices.

As a UM Coordinator, you will be tasked with collecting and reviewing clinical data and resources to help achieve positive outcomes for our consumers. The position offers a challenging environment, as our processes and procedures are subject to frequent updates due to evolving CMS rules and regulations. Maintaining a high standard of quality is essential, as monthly performance requirements must be consistently met.

Our mission emphasizes the health of our teammates, company, and customers. We are committed to fostering a workplace where every team member feels valued, respected, and treated with kindness. Collaboration and continuous learning are central to our approach, allowing us to develop the best solutions for those we serve. We are dedicated to fulfilling our purpose by consistently delivering excellent service to our customers.

This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital.

In this role you will:

• Take inbound calls to engage members and/or providers to verify clinical information, typically 30-50 calls daily.

• Handle customer inquiries both telephonically and by fax

• Learn how to maneuver our process flow to effectively handle customer requests

• Provide excellence customer service to our customers

• Document all call information according to standard operating procedures and attach clinical information when necessary

• Use multiple systems, therefore the ability to maneuver multiple systems at one time is vital.

• Identify and escalate issues

Use your skills to make an impact

Required Qualifications

• Prior customer service and/or call center experience

• Proficiency in Microsoft Office applications, including Word and Excel

• Excellent verbal and written communication skills

• Ability to multitask within several computer systems while on the phone

• Aptitude for quickly learning and navigating new technology systems and applications

• Typing skills

Preferred Qualifications

• Proficient utilizing electronic medical record and documentation programs

• Proficient and/or experience with medical terminology and/or ICD-10 codes

• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Workstyle: Remote work at Home

Location: U.S.

Schedule: Must be available to work any shift between the hours of 7 am - 7pm Central. Most shifts are 8 1/2 hours with a potential to rotate on holidays and weekends as needed.

Travel: None

Work at Home Guidance 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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Alert Humana values your personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.