Utilization Management (UM) Clinical Support Specialist (Remote)

American RENOLIT Corporation; Phoenix (AZ); À distance; USD 60 000 - 85 000; Plein temps

Résumé du poste

tango is a leader in home health management seeking a UM Clinical Support Specialist to join our growing team in Phoenix, AZ. The role focuses on data collection, analysis, reporting, and maintaining utilization and productivity logs to support decision making.

You will assist the UM leadership, manage referrals for completeness, support QA and compliance processes, and handle non-clinical calls and administrative tasks to keep the clinical team efficient in a fast-paced environment.

Qualifications

• Associate degree in healthcare administration, business administration, or related field required; Bachelor’s preferred.
• Proven experience in healthcare support with data collection and reporting.
• Experience supporting clinical teams and handling admin tasks in healthcare.

Responsabilités

• Collect and analyze data, maintain utilization and productivity logs.
• Develop and monitor reports on utilization trends and staff performance.
• Review referrals for completeness and obtain required clinical information.
• Handle non-clinical calls and administrative tasks for the clinical team.
• Assist with PA/RA/Appeals process and documentation.

Connaissances

Analytical skills

Communication skills

Multitasking

Teamwork

Formation

Associate degree

Bachelor's degree

Outils

Excel

Power BI

Database management systems

Description du poste

• Employee Type Full-Time (40 hours/wk)
• Required Degree 2 Year Degree
• Manage Others No

Contact information

• Name Human Resources

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 7600 North 16 th Street, Suite 140 Phoenix, AZ 85020
• 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.