Utilization Management Coordinator

Humana

. Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits .

Posted 10/28/2026full-timeRemote • United StatesJuniorMid-Level💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in handling inbound and outbound calls related to prior authorizations and utilization management, with a strong focus on customer service within the healthcare sector. Proficient in navigating multiple systems and documenting case activities while ensuring compliance with established procedures.

Highest-signal resume keywords

Customer Service ExperienceUtilization ReviewPrior Authorization ProcessesMedical Terminology KnowledgeProficiency in Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Typing ProficiencyElectronic Medical Record ProgramsICD-10 Codes KnowledgeUtilization Management ConceptsCase ProcessingError ResolutionDocumentation SkillsResearch SkillsInformation EvaluationHigh-Volume Call Management

Soft Skills

ProfessionalismAdaptabilityReliabilityCommunication SkillsTeam Collaboration

Tools & Technologies

Microsoft OfficeInternet Router ConnectionVirtual Meeting PlatformsDocumentation Programs

Industry Keywords

HealthcareInsuranceHealth ServicesManaged Care OrganizationPHI/HIPAA Compliance

About the role

Key responsibilities & impact

Handle inbound and outbound calls about prior authorizations, utilization management services, and benefits
Help providers and members navigate utilization management processes
Process and review prior authorization requests and documentation
Research and evaluate information supporting medical necessity determinations and authorization workflows
Perform case research, record updates, error resolution, and timely case processing
Review, verify, and enter accurate information across multiple systems
Document interactions, research findings, and case activities according to established procedures
Complete and monitor assigned work queues to meet service level agreements and turnaround requirements
Collaborate with clinical and operational teams and internal partners to resolve issues and escalated concerns
Meet productivity, quality, service, and attendance expectations
Adapt to changing priorities and support phone and non-phone responsibilities
Complete mandatory first-month training Monday through Friday from 8:00 AM to 4:30 PM CST
Receive cross-training across multiple lines of business and utilization management functions

Requirements

What you’ll need

Minimum of 2 years of customer service experience
Experience managing a high-volume of calls, approximately 30 to 50 calls daily, using multiple computer systems while engaging callers
Typing proficiency of at least 30 words per minute
Proficient experience using Microsoft Office
Direct wired connection to an internet router; Wi-Fi is not permitted
Dedicated, distraction-free, professional workspace with a closed door
Ability to participate in meetings and training with a webcam
Ability to work scheduled 8-hour shifts ending no later than 7:00 PM CST/8:00 PM EST, including one weekend day and holiday rotation
Customer service experience within healthcare, insurance, or health services preferred
Experience with Utilization Review and Prior Authorization within a managed care organization preferred
Proficiency using electronic medical record and documentation programs preferred
Knowledge of Medical Terminology and ICD-10 codes preferred
Exceptional attendance and reliability
Professionalism while working remotely
Comfort appearing on camera when required
Comfort learning complex information through virtual training
Knowledge of utilization management concepts, prior authorization processes, and medical coding
Ability to learn new systems quickly and adapt to changing business needs
Minimum download speed of 25 Mbps and upload speed of 10 Mbps for self-provided internet service
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Cross-training to support multiple lines of business and utilization management functions
Remote work arrangement
Potential occasional travel to Humana offices for training or meetings