Utilization Review Coordinator at Humana, Philadelphia, Pennsylvania

Company Overview: Humana is a leading healthcare company dedicated to helping people achieve their best health. With a focus on improving the health and well-being of individuals, Humana offers a wide range of insurance products and health services. The company is committed to delivering personalized, coordinated care to its members to ensure they have access to high-quality healthcare. Key Responsibilities For Utilization Review Coordinator: - Conduct utilization review activities to ensure appropriate use of healthcare services - Review medical records and treatment plans to determine medical necessity and appropriateness of care - Collaborate with healthcare providers to gather necessary information for review - Evaluate clinical documentation and make recommendations for care management - Communicate with insurance providers and healthcare professionals regarding utilization review decisions - Maintain accurate and detailed documentation of review activities - Stay updated on industry regulations and guidelines related to utilization review processes Required Qualifications: - Bachelor's degree in Nursing, Healthcare Administration, or a related field - 2+ years of experience in utilization review or a similar role within the healthcare industry - Strong knowledge of medical terminology, healthcare regulations, and clinical documentation - Excellent analytical and critical thinking skills - Ability to work independently and make sound decisions based on established criteria - Effective communication skills with the ability to interact with diverse stakeholders - Proficiency in using computer software for documentation and analysis Desired Skills: - Certification in Utilization Review (URAC) or Case Management (CCM) - Experience working with managed care organizations or insurance companies - Familiarity with electronic health record systems and utilization review software - Ability to identify opportunities for process improvement and implement best practices - Strong organizational skills and attention to detail - Ability to prioritize tasks and meet deadlines in a fast-paced environment Compensation & Benefits: The annual salary range for the Utilization Review Coordinator position at Humana in Philadelphia, Pennsylvania is $60,000 - $75,000, commensurate with experience. In addition to competitive pay, Humana offers a comprehensive benefits package that includes medical, dental, and vision insurance, 401(k) retirement plan with company match, paid time off, employee assistance program, and professional development opportunities. How to Apply: To apply for the Utilization Review Coordinator position at Humana in Philadelphia, Pennsylvania, please visit our careers website and submit your resume and cover letter outlining your qualifications and interest in the role. We look forward to reviewing your application and potentially welcoming you to our team at Humana.