Back to search
Become a part of our caring community
Ā
The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.PLEASE NOTE: This role will follow a four-day, 10-hour shift schedule within a Wednesday through Sunday work week. The assigned schedule will be either Wednesday through Saturday or Thursday through Sunday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time.
The Compliance (UM) Coordinator 3Ā collects and analyzes data daily, weekly, monthly,Ā or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operatingĀ objectives, including their linkages to relatedĀ workstreams.Ā Makes decisionsĀ regardingĀ own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.Ā Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determineĀ appropriate coursesĀ of action.Ā Follows established guidelines, regulatory turnaround times, andĀ proceduresĀ for processing QIO fast track appeals and expedited authorization requests.Ā Ā Ā
Use your skills to make an impact
Ā
Required QualificationsĀ
1 - 3 years of technical experienceĀ
Proficient in Microsoft Word & ExcelĀ
Strong attention to detail and accuracyĀ
Must be passionate about contributing to an organization focused on continuously improving consumer experiencesĀ
Excellent verbal and written communication skillsĀ
Clerical support background in a healthcare environmentĀ
Ability to work independently in an agile environment under general instructions and within a team.Ā
āÆĀ
Preferred QualificationsĀ
UM experience with auditing or complianceĀ
UM experienceĀ withĀ processingĀ expeditedĀ requestsĀ orĀ QIOĀ appealsĀ Ā
The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ monthsĀ
Associates'Ā orĀ Bachelor's degree in Healthcare, Business. Finance, or related fieldĀ
Familiarity with medical terminology and/or ICD-10 codesĀ
āÆĀ
Additional InformationĀ
This position is within a department thatĀ operatesĀ in EST.Ā
This position offers a flexible scheduleāÆofāÆMonday to Sunday, between 8 am and 8 pm EST with occasional overtime.Ā
This position follows a 4-day workweek consisting of ten-hour shifts, available schedules include:Ā Ā
Wednesday - Saturday
Thursday - Sunday Ā
Ā
Work-At-Home RequirementsĀ
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).Ā
A minimum standard speed forĀ optimalĀ performance is 25mbsĀ downloadĀ x 10mbs uploadĀ isĀ required.Ā
Check your internet speed atāÆwww.speedtest.netĀ
A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA informationāÆĀ
Ā
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Ā
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.
Ā
Ā
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, āHumanaā) 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.
About us
Ā
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 ā 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atāÆHumana.comāÆand atāÆCenterWell.com.ā
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.
Learn more about this Employer on their Career Site
