Sr. Utilization Management Coordinator Professional 1

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Job Information
Humana
Sr. Utilization Management Coordinator (Professional 1)
in
Cincinnati
Ohio
Description
The Senior UM Coordinator contributes to administration of utilization management by providing non-clinical support for the Ohio Medicaid Peer to Peer review process, ensuring best and most appropriate treatment, care or services for members.
Responsibilities
The Senior UM Coordinator manages the requests from providers for Peer to Peer discussions after an authorization is denied. .
Job Responsibilities
Receives requests for Peer to Peer discussions from providers via email and telephone.
Monitors email, phone and work queue in the clinical documentation system, ensuring that contractual processing and timeliness standards are met.
Schedules the P2P discussions according to the Ohio Department of Medicaid (ODM) timeliness standards
Communicates the details of the authorization request, including clinical documentation to Medical Directors
Documents the outcome of the P2P process in the clinical documentation system.
When letters to the provider and member are required, the SUMC processes and sends the letters.
Communicates with external providers, office staff, internal Medical Directors, Utilization and Care Management Nursesand Coordinators in a professional, succinct manner with the aim of providing timely medically necessary services to members.
Required Qualifications
Minimum 2 yearsMinimum 2 years clinical, healthcare, payer or pharmacy-related environment experience
Strong problem-solving and analytical skills
Demonstrates excellent presentation and communications skills, along with customer service, sales experience or similar work where an expectation was a high level of sensitivity and understanding of customer needs
Possess the ability to take initiative and work independently, and exercise appropriate business judgment
Strong analytical and financial analysis skills, including reporting
Intermediate working knowledge of Microsoft Office applications including high level of understanding of Excel, Word, Access, PowerPoint, multiple systems and platforms, and able to troubleshoot and resolve general technical difficulties.
Ability to handle changing priorities yet maintain processes and work flow so as to assure an on-time delivery of expected work
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Additional Requirements/Adherence
Workstyle:
Remote work at homeLocation: Ohio
Hours:
40 hour work week Monday through Friday 8:00 AM to 5:00 PM Eastern Time and ocassional over time as needed to support the business
Travel
: 5-10% to attend meetings and or required onsite training
Work at Home Requirements:
Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
Must have accessibility to hardwired high speed internet with minimum speeds of 25Mx10M for a home office (Wireless and Satellite are prohibited)
Preferred Qualifications
Associate or Bachelor's degree in health or business related area of focus.Previous Utilization Management experience.
Previous Medicaid experience.
Previous experience in payer or provider Peer to Peer process management.
Knowledge and use of clinical documentation system or Electronic Medical Record
Previous experience planning and managing deliverables to support various types of projects
Additional Information
For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
Medical, religious, state and remote-only work exemptions are available.
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may 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. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

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