Utilization Management Coordinator

Humana

. Process and document incoming inpatient and outpatient prior authorization requests according to Humana policies and procedures .

Posted 10/21/2026full-timeRemote • Wisconsin • United StatesJunior💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing and documenting prior authorization requests while ensuring compliance with Humana policies. Proficient in customer service and communication, effectively managing inbound and outbound calls in a healthcare setting.

Highest-signal resume keywords

Prior Authorization ExperienceCustomer Service ExperienceMicrosoft Office ProficiencyTruCare Database ManagementHealth Insurance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ProcessingDocumentation SkillsData EntryClinical Review CoordinationMultitasking

Soft Skills

Effective CommunicationInterpersonal SkillsProblem-Solving

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPointTruCare Database

Industry Keywords

Healthcare SettingHealth PlanUtilization ManagementPHI ComplianceHIPAA Compliance

About the role

Key responsibilities & impact

Process and document incoming inpatient and outpatient prior authorization requests according to Humana policies and procedures
Contact providers by phone or fax to request additional information or clarification
Conduct inbound and outbound calls
Work with internal and external customers and providers regarding prior authorization request status
Take provider calls regarding prior authorization status
Enter prior authorization requests into the TruCare database
Prepare documentation and assign tasks to appropriate staff for clinical review
Multitask throughout the day to meet the needs of multiple stakeholders

Requirements

What you’ll need

One (1) year of experience working in a health care setting or health plan setting
1–2 years of experience working in Microsoft Office software applications, specifically Word, Excel, and PowerPoint
1 year of customer service experience with either inbound and outbound phone calls
Work 8:30–5:00 pm CST, Monday through Friday, with limited availability for rotated holiday coverage
Preferred: 1 year of experience in prior authorization or utilization management
Preferred: 1 year of experience working in a health insurance environment
Preferred: Reside in the State of Wisconsin
Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Remote home workstyle
Occasional use of Humana office space for collaboration and face-to-face needs
Internet service requirements/support for home work
Dedicated workspace to protect member PHI/HIPAA information