CarePlus Health Plans, a Humana company, is hiring a Prior Authorization UM Coordinator to provide essential non-clinical support for utilization management policies. In this role, you will ensure appropriate treatment for members by assisting UM Nurses with discharge coordination and administrative tasks.
What You'll Do
- Support UM Nurses to process discharge orders and arrange safe facility discharges.
- Collaborate with UM Nurses, Pharmacy, Medical Directors, and other departments.
- Make calls to UM Nurses, Hospitals, Skilled Nursing Facilities, and other vendors.
- Document all calls and requests.
- Search for Medicare and Medicaid guidelines.
- Process all incoming fax and email requests for services the same day.
- Return calls for all voice messages received the same day.
- Process provider and member letters (Letter of Agreements, Approvals, Denials, etc.).
- Mail letters to members.
- Assist the team with various clerical and administrative tasks as necessary.
- Participate in special projects as assigned by your Supervisor or Manager.
What We're Looking For
- 1 or more years of experience with Utilization Review and/or Prior Authorization.
- 1 or more years of Healthcare experience.
- Working knowledge of Microsoft Word, Excel, and Outlook.
- Must live in CST or EST states.
- Schedule: Monday–Friday 8am-5pm EST, with work required for 1 weekend per quarter. Schedule is subject to change.
Nice to Have
- Bilingual English/Spanish.
- Proficient utilizing documentation programs.
- Experience with the CarePlus Platform.
- Proficient and/or experience with medical terminology and/or ICD-10 codes.
- Member services experience.
Technical Stack
- Microsoft Word, Excel, Outlook
- CarePlus Platform
- Documentation programs
Team & Environment
You will work with UM Nurses, Pharmacy, Medical Directors, and other departments, reporting to a Supervisor or Manager.
Benefits & Compensation
- Compensation: $40,000 - $52,300 per year.
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
- Short-term and long-term disability insurance.
- Life insurance.
Work Mode
This is a remote position open to candidates residing in CST or EST states.
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.
