Compliance UMAC 3 (M-F)

Role Overview

The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure compliance with policies, procedures, and applicable regulations. The role includes independent judgment in handling varied, sometimes ambiguous assignments.

Schedule / Work Setup

• Four-day, 10-hour shift schedule during the standard Monday–Friday work week
• Either Monday–Thursday or Tuesday–Friday
• Work hours: 8:00 a.m. to 8:00 p.m. ET
• Operates in EST time
• Work-at-home with occasional travel for training/meetings

Responsibilities

• Collect and analyze data daily, weekly, monthly, or as needed to assess outcomes and operational metrics
• Interpret guidelines and independently determine appropriate next steps in complex/varied situations
• Ensure adherence to regulatory turnaround times
• Process QIO fast track appeals and expedited authorization requests according to established procedures
• Understand department and organizational strategy and how it links to related workstreams

Required Qualifications

• 1–3 years of technical experience
• Proficient with Microsoft Word & Excel
• Strong attention to detail and accuracy
• Excellent verbal and written communication skills
• Healthcare clerical support background
• Ability to work independently in an agile environment under general instructions and within a team

Preferred Qualifications

• UM experience with auditing or compliance
• UM experience processing expedited requests or QIO appeals
• Current experience on Humana’s One Home / Home Solutions UM team for 12+ months
• Associates’ or Bachelor’s degree in Healthcare, Business, Finance, or related field
• Familiarity with medical terminology and/or ICD-10

Remote Requirements (Work-at-Home)

• High-speed wired DSL or cable modem; satellite and wireless are not allowed
• Minimum internet: 25 Mbps download / 10 Mbps upload (wireless/wired cable/DSL suggested; wireless may be limited by role requirements)
• Dedicated office space with minimal interruptions to meet productivity needs and protect member PHI/HIPAA

Travel

• Occasional travel to Humana offices for training or meetings may be required