DescriptionThe UM Specialist contributes to administration of utilization management. The UM Specialist performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
Role: UM Specialist
Location: Torrance, CA
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.
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. This is an office based position working out of the Torrace, CA location. Hours for this position are Monday - Friday, 8:30 am - 5:30 pm Pacific Time.
- 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
- Collaborate with multiple roles/departments/providers/team members
- 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
- Role Desirables
- 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
Scheduled Weekly Hours40