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

The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support to healthcare providers contacting the call center to initiate referral authorizations or check the status of existing requests. This role requires strong communication skills, attention to detail, and the ability to work efficiently in a fast-paced, high-volume environment. The Coordinator serves as a key liaison between providers and internal UM teams, ensuring timely and accurate processing of referral and authorization inquiries in accordance with organizational policies and regulatory guidelines.

The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.

• Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests.
• Accurately gather, verify, and enter provider and member information into the appropriate systems.
• Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements.
• Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management.
• Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines.
• Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times.
• Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed.
• Maintain thorough documentation of all interactions and transactions in accordance with company standards.
• Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures.
• Adhere to all applicable privacy, confidentiality, and compliance regulations.

Use your skills to make an impact
 

Required Qualifications

• 1 or more years administrative or technical support 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

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

About us
 

About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach