Utilization Management Specialist - Work at home, Texas residence preferred

Humana Inc. San Antonio, TX
Role: UM Specialist

Assignment: Medicare

Location: Work at Home, Texas Residence Preferred

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.

Assignment Capsule

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.

Ideal 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. Hours for this position are Monday - Friday, 8:30 am - 5:30 pm CST.

Key Responsibilities:

Majority of the time will be dedicated to 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

Role Essentials

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

Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.

Role Desirables

Texas residency preferred

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

Reporting Relationships

You will report to a Frontline Leader

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.