Compliance UMAC 3 (Wed-Sun)

Become a part of our caring community   The Compliance (UM) Coordinator 3 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance (UM) Coordinator 3 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. PLEASE NOTE: This role will follow a four-day, 10-hour shift schedule within a Wednesday through Sunday work week. The assigned schedule will be either Wednesday through Saturday or Thursday through Sunday, with work hours scheduled between 8:00 a.m. and 8:00 p.m. Eastern Time. The Compliance (UM) Coordinator 3   c ollects and analyzes data daily, weekly, monthly ,   or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating   objectives , including their linkages to related   workstream s .   Makes decisions   regarding   own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.   Assignments are varied and often complex, requiring independent judgment, critical thinking, and interpretation of guidelines to determine   appropriate courses   of action.   Follows established guidelines , regulatory turnaround times, and   procedures   for processing QIO fast track appeals and expedited authorization requests.      Use your skills to make an impact   Required Qualifications   1 - 3 years of technical experience   Proficient in Microsoft Word & Excel   Strong attention to detail and accuracy   Must be passionate about contributing to an organization focused on continuously improving consumer experiences   Excellent verbal and written communication skills   Clerical support background in a healthcare environment   Ability to work independently in an agile environment under general instructions and within a team.

UM experience with auditing or compliance   UM experience   with   processing   expedited   requests   or   QIO   appeals    The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months   Associates'   or   Bachelor's degree in Healthcare , Business. Finance, or related field   Familiarity with medical terminology and/or ICD-10 codes       Additional Information   This position is within a department that   operates   in EST.   This position offers a flexible schedule of Monday to Sunday, between 8 am and 8 pm EST with occasional overtime.   This position follows a 4-day workweek consisting of ten-hour shifts, available schedules include:    Wednesday - Saturday Thursday - Sunday     Work-At-Home Requirements   Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).   A minimum standard speed for   optimal   performance is 25mbs   download   x 10 mbs upload   is   required .   Check your internet speed at   www.speedtest.net   A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information     Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect