Humana UM Administration Coordinator 2 - Behavioral Health UM - Remote, US in San Juan, Puerto Rico
The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
The Utilization Management (UM) Administration Coordinator 2 contributes to the success of Humana's business strategy by collecting broad based information and gathering resources and data in order to prepare the Behavioral Health( BH) Clinical Team with the tools necessary to enhance consumer engagement, choice, and trust. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
In this role you will:
Assist BH Team with various clerical and administrative tasks as necessary
Process notifications, authorizations, and referrals not requiring clinical review
Appropriately route cases needing clinical follow-up to appropriate BH clinician
Accurately update cases with dates of service, corrected facility, MD, and diagnosis information
Ensure members are picked up by BH team in a timely manner
Verify whether Humana is the primary payor
Answer inbound calls
Complete fax clinical process
Attach clinical voicemails to cases
Make outbound phone calls to complete authorization process and communicate status
Participate in special projects as assigned by the BH Supervisor/ Manager or Director
Experience working with the behavioral health population
Excellent verbal and written communication skills
Must possess interpretive, intuitive and investigative skills
Excellent organizational and time management skills
Strong attention to detail
Ability to work independently with clear direction and as part of a team
Proficiency in all Microsoft Office applications, including Word and Excel
Skilled in web navigation
Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
Designated/ Secured work area to conduct business
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Associate's or Bachelor's Degree in Healthcare, Business, Finance or a related field
Minimum of 1 year of managed care experience
Familiarity with medical terminology and/or ICD-9 codes
Knowledge of BH terminology, care concepts and unique characteristics of a BH members
Experience with behavioral change, health promotion, coaching and wellness
Experience working with the older adult population
Ability to work a flexible work schedule
Knowledge of community health and social service agencies and additional community resources
Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Hours may include working until 6:30 PM CST M-F
*Weekend hours based upon business need
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Scheduled Weekly Hours
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