Utilization Review Coordinator at Humana, Providence, Rhode Island

Company Overview:
Humana is a leading healthcare company dedicated to helping people achieve lifelong well-being. With a focus on providing personalized, proactive, and integrated healthcare services, Humana is committed to improving the health and wellness of individuals and communities.

Key Responsibilities For Utilization Review Coordinator:
- Conduct utilization review activities to ensure appropriate levels of care are being provided to Humana members
- Review and analyze medical records, treatment plans, and other relevant documentation to determine medical necessity and appropriateness of services
- Collaborate with healthcare providers to obtain additional information or clarification as needed
- Maintain accurate and detailed documentation of all utilization review activities
- Monitor and track utilization review metrics to identify trends and opportunities for improvement
- Stay current on industry regulations and best practices related to utilization review processes

Required Qualifications:
- Bachelor's degree in Nursing, Healthcare Administration, or related field
- Minimum of 2 years of experience in utilization review or a similar role within the healthcare industry
- Strong knowledge of medical terminology, healthcare regulations, and utilization review principles
- Excellent analytical and critical thinking skills
- Effective communication and interpersonal abilities
- Ability to work independently and as part of a team in a fast-paced environment

Desired Skills:
- Certification in Utilization Review (URAC) or Case Management (CCM)
- Experience working with electronic health records (EHR) systems
- Knowledge of insurance and reimbursement processes in healthcare
- Ability to multitask and prioritize workload effectively
- Continuous learning mindset to adapt to changing healthcare landscape

Compensation & Benefits:
The annual salary range for the Utilization Review Coordinator position at Humana in Providence, Rhode Island is $55,000 - $70,000, commensurate with experience. In addition to competitive pay, Humana offers a comprehensive benefits package that includes medical, dental, vision, and prescription drug coverage, as well as retirement savings plans, paid time off, and professional development opportunities.

How to Apply:
To apply for the Utilization Review Coordinator position at Humana in Providence, Rhode Island, please visit our careers website and submit your resume and cover letter outlining your qualifications and interest in the role. We thank all applicants for their interest in joining Humana's mission to improve the health and well-being of our members.