Manager, UM Administration

The Manager, UM Administration provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. This role supports Humana Clinical Pharmacy Review (HCPR) Appeals and Reimbursement departments for prior authorizations on pharmaceuticals. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

• Bachelor's Degree
• Prior demonstrated experience with process improvement or process design and implementation roles
• Comprehensive knowledge of all Microsoft Office applications and strong database software proficiency
• Progressive experience in the health service industry, healthcare finance or healthcare related consulting
• Deep understanding of strategic planning, customer loyalty and retention programs, and primary and secondary research processes
• Strategic thinking and business planning capabilities; organized and detail-oriented
• Excellent written and verbal communication skills
• Demonstrated presentation skills
• Willingness to manage and prioritize diverse projects & reports
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Experience with PaHub, SS&C, and CRM
• Master's Degree
• 3 - 5 years of work experience in an operational setting
• General understanding of economic, financial and operational concepts
• Previous supervisory experience in a call center setting

Additional Information:

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business …