Humana · 4 days ago
Utilization Management Administration Coordinator - Phone Intake
United States
Full-time
Remote
Entry Level
$40K/yr - $52K/yr
1+ years expHumana, through Conviva Care Solutions, is seeking a Utilization Management Administration Coordinator to provide support to healthcare providers for referral authorizations. The role involves managing incoming calls, processing requests, and collaborating with clinical staff to ensure efficient case management while adhering to compliance regulations.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests
Accurately gather, verify, and enter provider and member information into the appropriate systems
Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements
Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management
Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines
Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times
Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed
Maintain thorough documentation of all interactions and transactions in accordance with company standards
Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures
Adhere to all applicable privacy, confidentiality, and compliance regulations
Qualification
Required
1 or more years administrative or technical support experience
Excellent verbal and written communication skills
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems
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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Proficient utilizing electronic medical record and documentation programs
Proficient and/or experience with medical terminology and/or ICD-10 codes
Bachelor's Degree in Business, Finance or a related field
Prior member service or customer service telephone experience desired
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase