About This Role
This Compliance (UM) Coordinator role involves reviewing utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The coordinator collects and analyzes data to assess outcome and operational metrics for the team and individuals, making decisions regarding work methods in varied and often complex situations. The role requires independent judgment, critical thinking, and interpretation of guidelines to determine appropriate courses of action, particularly for QIO fast track appeals and expedited authorization requests.
Responsibilities
- Review utilization management activities and documentation to ensure adherence to policies, procedures, and regulations
- Collect and analyze data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals
- Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction
- Follow established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests
Requirements
- 1 - 3 years of technical experience
- Proficient in Microsoft Word & Excel
- Strong attention to detail and accuracy
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Excellent verbal and written communication skills
- Clerical support background in a healthcare environment
- Ability to work independently in an agile environment under general instructions and within a team
Nice to have:
- UM experience with auditing or compliance
- UM experience with processing expedited requests or QIO appeals
- Current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months
- Associate's or Bachelor's degree in Healthcare, Business, Finance, or related field
- Familiarity with medical terminology and/or ICD-10 codes
Benefits
- Competitive benefits that support whole-person well-being
- Associate benefits designed to encourage personal wellness and smart healthcare decisions
Important Details
- Schedule: three-day workweek consisting of 12-hour shifts, with schedule options of Friday-Sunday or Saturday-Monday, between 8:00 a.m. and 9:00 p.m. Eastern Time
- Travel: occasional travel to Humana's offices for training or meetings may be required
About the Company
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being.
