[Remote] UM Coordinator 2 – Amazon Store

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Note: The job is a remote job and is open to candidates in USA. Humana Inc. is committed to putting health first for their teammates and customers. The UM Coordinator 2 will contribute to the administration of utilization management by assisting providers with authorization processes and ensuring compliance with guidelines and regulations.

Responsibilities

• Responsible for taking inbound calls and assisting providers in determining whether a specific service for a member requires prior authorization or referral, ensuring compliance with established guidelines and processes.
• Initiate the authorization process by collecting clinical information and verifying medical necessity, ensuring members are not subjected to unnecessary services or expenses.
• Responds to provider inquiries regarding existing authorizations or referrals, and provides timely updates as needed through fax or inbound phone line, ensuring compliance with organizational policies and applicable federal regulations.
• Document all call information according to standard operating procedures and attach clinical information when necessary
• Support members with authorization requests, including outbound calls to provider offices when required.
• Review resources and data to facilitate positive outcomes for consumers, adapting to ongoing changes in processes and procedures due to CMS regulations.
• Maintain high-quality standards and meet monthly quality requirements
• Ability in maneuvering multiple systems simultaneously

Skills

• Minimum 1 year of customer service experience, including the ability to effectively de-escalate challenging situations
• After training, you must be available to work any shift between the hours of 6am - 7pm CST and occasional weekends based on business needs
• Excellent verbal and written communication skills
• Demonstrated attention to detail
• Ability to navigate process flows and follow procedure documents
• Proficient keyboarding skills for data entry and documentation
• Capacity to multitask across various computer systems while engaging with providers or members
• Quick aptitude for learning and navigating new technology systems and applications
• Proficiency in Microsoft Office applications, including Word and Excel
• A designated workspace, with a closed door, that minimizes distractions and meets leadership approval
• Must effectively manage personal responsibilities to ensure a professional work environment conducive to achieving performance goals
• Proficient utilizing electronic medical record and documentation programs
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
• Knowledge of Medical Terminology and/or ICD-10 codes
• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
• Bilingual (English & Spanish) fluent in written and verbal communication

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities
• Medical, dental and vision benefits
• Short-term and long-term disability
• Life insurance

Company Overview

• Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.

Company H1B Sponsorship

• Humana has a track record of offering H1B sponsorships, with 202 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.