UM Specialist - Work at home Mountain and Pacific Time Zone only

Profile

Description

The UM Specialist contributes to administration of utilization management. The UM Specialist performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

Humana's dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana's Perfect Experience means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Be a part of our Clinical Space- Provide guidance to facilitate interaction or services that connect people with lifelong well-being. As a UM (Utilization Management) Specialist you will contribute to the success of Humana's business strategy by collecting broad based information and gathering resources and data in order to arm the team with the tools necessary to enhance consumer engagement, choice, and trust.

I deal Skillset

Preferred applicants will have a clerical support background in a healthcare environment (Certified Nurse Aide, Medical Assistant, or medical coding is valuable), possess excellent phone etiquette, communication skills and demonstrate proficiency with MS Office products; particularly Word, Excel and Outlook. .

Key Responsibilities:


Attaching faxes for chart reviews for the nursing team
Answering departmental phones as assigned
Make outbound calls to engage members and/or providers to verify clinical information/discharge date and admission status
Document calls and attach clinical information received
Request clinical information from providers/facilities
Create and send out written correspondence
Ability to multitask and prioritize
Collaborate with multiple roles/departments/providers/team members


Require Qualifications


Mountain or Pacific Time zone residency
High School Diploma
Proficiency in all Microsoft Office applications, including Word, Excel and Outlook
Exceptional phone etiquette
Excellent communication skills, both verbal and written
Working knowledge of computers, or a demonstrated technical aptitude 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); and recommended speed for optimal performance for Humana systems is 10Mx1M


Preferred Qualifications


Associate's or Bachelor's Degree in Business, Finance or a related field
Clerical support background in a healthcare environment
Familiarity with medical terminology and/or ICD-10 codes
Experience working in a call center environment a plus
CNA or Medical Assistant background a plus


Additional Information:

Hours for this position will be an 8 hour shift between the hours of 7 am and 6 pm Mountain or Pacific Time, Monday - Friday

Scheduled Weekly Hours

40

Company info

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