Utilization Management (UM) Coordinator

Humana is seeking a Utilization Management (UM) Coordinator to join the Wisconsin Medicaid Market (iCare) team. As a UM Coordinator, you will provide non-clinical support for policies and procedures to ensure best and most appropriate treatment, care, or services for members.

Responsibilities:

• 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.
• Conduct inbound and outbound calls.
• Work with customers/providers, both internally and externally, regarding the status of PA requests.
• Enter PA requests into the prior authorization database (TruCare), prepare documentation, and tasks to the appropriate staff member for clinical review.
• Multitask consistently throughout the day to meet the needs of multiple stakeholders.

Requirements:

• One (1) year of experience working in a healthcare 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 Monday through Friday, 8:30-5pm CST (limited availability needed for rotated holiday coverage).

Preferred Qualifications:

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

Benefits:

• Competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and more.

Workstyle:

• Remote workstyle, with occasional travel to Humana's offices for training or meetings.

Scheduled Weekly Hours:

• 40

Pay Range:

• $40,000 - $52,300 per year