Utilization Management Clinical Support Specialist (Remote)

tango; United States; Remote; USD 52,000 - 72,000; Full time

Job summary

tango is seeking a UM Clinical Support Specialist to support the Utilization Management team. The role involves collecting and analyzing utilization data, maintaining productivity logs, and producing reports to guide decisions.

You will assist the clinical team with referrals, documentation, and non-clinical tasks while ensuring compliance and timely communication. Office is in Phoenix, AZ with remote work options.

Qualifications

• Associate degree in healthcare administration is required; Bachelor’s preferred.
• Proven experience in data collection and reporting within healthcare.
• Experience supporting clinical teams and administrative tasks in healthcare services.

Responsibilities

• Collect, analyze, and report utilization and productivity data.
• Maintain utilization and productivity logs and develop reports.
• Review referrals for completeness and obtain clinical information when needed.
• Provide administrative support to the clinical team and handle non-clinical calls.
• Assist with PA/RA/Appeals processes and documentation.

Skills

Data collection

Reporting

Healthcare support

Organizational skills

Communication

Education

Associate degree in healthcare administration

Bachelor’s degree preferred

Tools

Excel

Power BI

Database management

Job description

tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.

We are currently looking for a UM Clinical Support Specialist to join our growing team!

The UM Clinical Support Specialist plays a vital role in supporting the leadership of the Utilization Management team by collecting, analyzing, and reporting data. This position is responsible for maintaining utilization and productivity logs, developing, and monitoring reports, and ensuring accurate and timely documentation. The role also provides administrative support to the clinical team by managing inbound and outbound calls that do not require clinical intervention, review referrals for completeness, assisting reviewers with obtaining clinical information when needed, and supporting compliance, training, and appeal processes

Office Location:

• Office located at 2415 East Camelback Road, Suite 700 Phoenix, AZ 85016
• Remote

Essential Functions:

• Works independently with minimal supervision and demonstrates accountability for work quality.
• Support the UM Director and Supervisor in data collection and analysis.
• Creates and manage comprehensive reports on utilization and productivity and performance trends.
• Reviews the human resource credentialing reports with the Supervisor to ensure clinician licenses remain current in all applicable states.
• Monitors Relias for completion of mandatory training and ensure staff compliance within required timelines.
• Records and tracks QIO appeal requests and provides assistance as needed.
• Assists the clinical team by managing non-clinical calls, inquires and administrative tasks.
• Assists the clinical team by reviewing referrals for missing clinical documentation and obtaining clinical information from providers or facilities when necessary and providing decision notifications back to the providers.
• Assist UM reviewers with administrative tasks in relation to the PA/RA/Appeals process.
• Assist UM department with non-clinical RA decisions.
• Answers and resolves portal tickets in a timely manner.
• Maintains accurate logs, tracks data trends and identifies opportunities for process improvements.
• Exhibits a professional, pleasant and welcoming demeanor both in person and on the phone.
• Schedules 1:1 meetings for leadership and staff as directed.
• Other duties as assigned.

Qualifications:

• Associate degree in healthcare administration, business administration, or a related field required; Bachelor's degree preferred.
• Proven experience in a healthcare support role, particularly in data collection and reporting.
• Prior experience supporting clinical teams and handling administrative tasks related to healthcare services.

Knowledge and Experience:

• Proficiency in relevant software applications (e.g., Excel, Power BI, database management systems).
• General medical knowledge.
• Understanding of healthcare utilization management processes and terminology.
• Awareness of privacy regulations and data security practices in healthcare.
• Excellent organizational skills with strong attention to detail.
• Critical thinking and troubleshooting skills.
• Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
• Well-developed interpersonal and communication skills.
• Professional appearance and manner.
• Ability to work both independently and collaboratively in a team environment.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.