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Utilization Management Specialist - Long Beach/Torrance, CA
Humana | Long Beach, CA | 4/1/2014

Role: Utilization Management Specialist
Assignment: Medicare
Location: Long Beach/Torrance, CA
Humana’s dream is to help our members and our own associates achieve lifelong well-being.  Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference.  Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members.  We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.
Assignment Capsule
Be a part of our Clinical Space- Provide guidance to facilitate interaction or services that connect people with lifelong well-being.
As a Utilization Management Specialist you will contribute to the success of Humana’s business strategy by collecting broad based information and gathering resources and data in order to arm the team with the tools necessary to enhance consumer engagement, choice, and trust.

  • Make outbound calls to engage members and/or providers to verify clinical information
  • Conduct post discharge surveys
  • Document all calls and attach clinical information received
  • Create and send out written correspondence
Key Competencies
  • Accountability:  Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
  • Builds Trust:  Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
  • Collaborates:  Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.
  • Customer Focus:  Connects meaningfully with customers to build emotional engagement and customer advocacy.  Simplifies complexity and integrates internal efforts to deliver an optimal customer experience.  


Role Essentials

  • High School Diploma
  • Proficiency in all Microsoft Office applications, including Word, Outlook and Excel (formulas, filters and sorting)
  • Excellent communication skills, both verbal and written
  • Strong data entry skills and attention to detail 
  • Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
Role Desirables
  • Associate’s or Bachelor’s Degree in Business, Finance or a related field
  • Familiarity with medical terminology and/or ICD-9 codes
  • Bilingual in Spanish a plus
Reporting Relationships
You will report to a Front Line Leader.
Additional Information
Humana is an organization with careers that change lives—including yours.  As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives.  If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Apply now, or join our Talent Network so you can stay informed and up to date on what’s happening at Humana.


Employment Type: Full-Time
Base Pay: N/A
Other Pay:
Industry: Healthcare - Health Services
Education: Not Specified
Experience: Not Specified
Manages Others: Not Specified
Relocation: Not Specified
Required Travel: None
Job ID: 113347
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Throughout our 50-year history, Humana has always been one step ahead, constantly evolving with the changing world of healthcare. It is our proactive, forward-thinking approach that has allowed us to not only meet the needs of our customers, but also provide a challenging and exciting work experience for our associates.

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