Become a part of our caring community and help us put health first
Be a part of our Care Delivery Clinical Team – as a UM Administration Coordinator you will engage with the clinical team to coordinate the needed documentation and communication needed for our members to develop lifelong well-being and health and assure compliance with all regulatory requirements. Focus: Managing incoming calls… from providers/members. Works with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers. Process incoming referrals, and prior authorizations. Assists clinical staff with triaging cases for clinical review. Handle resolution/inquiries from members and/or providers.
Job Functions
• Work with providers to obtain, prepare, and disseminate clinical information for members admitted to either acute inpatient or post-acute or facilities, adhering to standard timeframes and procedures.
• Complete provider outreach within specified timeframes to obtain standard patient clinical information for all patients identified for review, per program workflow and protocols.
• Complete provider outreach on a daily basis to collect discharge information for all discharges and complete updates to patient discharge information in the clinical system.
• Monitor receipt of requested patient clinical information into assigned inbox and prepare for nurse use through timely identification and labeling.
• Monitor receipt of census reports from facilities and complete updates or case build using pertinent patient case information in the clinical system as needed.
• Complete updates to letters using the letters templates available in the system to support nurses and clinical leadership in sending the proper, timely correspondence to patients and providers.
• Complete required documentation, including but not limited to: UM Activity Documentation Form, referrals to Financial Recovery, etc.
• Provide general administrative support pertaining directly to clinical activities to the observation management and Concurrent Review clinical staff.
• Performs other responsibilities as required.
Use your skills to make an impact
Required Qualifications
• High School diploma
• 3-5 Administrative Experience
• Must have accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
• Familiar with medical terminology
• Experience in customer service
Preferred Qualifications
• Associates degree or higher preferred
• Health Plan experience preferred
• Medicaid/Medicare experience preferred
• Bilingual preferred
Alert
Humana and its subsidiaries values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.
Interview Format: MODERN HIRE
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.
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Scheduled Weekly Hours
40
Pay 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.
$40,200 – $55,200 per year
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Conviva: Conviva Care Centers provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients’ well-being.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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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