Utilization Management Coordinator

Utilization Management Coordinator at Humana in Boise, Idaho, United States Job Description Become a part of our caring community and help us put health first Humana is seeking a Utilization Management (UM) Coordinator to join the Wisconsin Medicaid Market team. The UM Coordinator provides non-clinical support for policies and procedures related to the administration of utilization management, ensuring the 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. + Communicate effectively 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. Use your skills to make an impact Required Qualifications + One (1) year of experience working in a health care setting. + Experience working in Microsoft Office software applications, specifically Word, Excel, and PowerPoint. + One (1) year of customer service experience answering phone calls. + Experience with and knowledge of ICD-10, HCPCS, and CPT codes. Preferred Qualifications + Experience in prior authorization or utilization management + Experience working in a health insurance environment or managed care setting. + Medical Assistant experience. 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) WAH Internet 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 recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Humana will provide Home or Hybrid Home/Office employees with telephone eq To view full details and how to apply, please login or create a Job Seeker account