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The coordinator provides non-clinical administrative support for utilization management, including managing shared mailboxes and entering data into clinical systems. They also facilitate communication between care coordinators, providers, and members to ensure appropriate care and service delivery.
Provide Long- Term Services and Supports (LTSS) UM support by managing shared mailboxes and entering data into work queues and/or clinical documentation systems.
Mail letters/educational material, prepare documents for LTSS UM (Utilization Management) reviewers and Medical Directors, and perform other administrative responsibilities as assigned.
Ensure the timely and correct submission of state-required deliverables.
Work with care coordinators and other internal and external stakeholders who guide members and their families toward and facilitate interaction with resources appropriate for care and well-being.
Perform varied activities of clerical activities including perform computations, reporting data, tracking data, pulling reports and monitoring/managing email.
Typically work on semi-routine assignments that are subject to change.
May make, receive, and soft transfer calls to and from members, member's families and providers.
Ensure timely communication and follow up occurs with care management.
Required Qualifications
Must reside in Michigan.
One (1) or more years of administrative experience in a healthcare environment.
Strong verbal and written communication skills to support stakeholder communication and coordination.
Working knowledge of Microsoft Word, Excel, and Outlook in a Windows-based environment and the ability to learn new software and systems.
Preferred Qualifications
Experience with LTSS programs.
Experience with LTSS Utilization Review and/or Prior Authorization, preferably within a managed care organization.
Proficient using electronic medical record and documentation programs.
Proficient or experienced with medical terminology and/or ICD-10 codes.
Prior member service or customer service telephone experience.
Additional Information
Workstyle: This position is remote.
Work Schedule: Monday through Friday; 8:00 a.m. to 4:30 p.m. Eastern Time (ET), with flexibility to work additional hours as needed to support business priorities and operational demands.
Training: The training period for this position is approximately 4 to 6 weeks and may require attendance outside of standard working schedule. We require full participation throughout onboarding and training to ensure successful completion of the program. While time off is generally not permitted during this period, we consider limited accommodations for essential needs on a case-by-case basis.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40Pay 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.
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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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