Utilization Management (UM) Coordinator

Humana · Remote Wisconsin · $40,000 - $52,300 per year · remote 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