Utilization Management (UM) Clinical Support Specialist (Remote)

Position Overview 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. This is a Non-Clinical role and clinicians will not be considered. Office Location Office located at 2415 E Camelback Road, Suite 700, 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. Create and manage comprehensive reports on utilization and productivity and performance trends. Review the human resource credentialing reports with the Supervisor to ensure clinician licenses remain current in all applicable states. Monitor Relias for completion of mandatory training and ensure staff compliance within required timelines. Record and track QIO appeal requests and provide assistance as needed. Assist the clinical team by managing non-clinical calls, inquiries and administrative tasks. Review referrals for missing clinical documentation and obtain clinical information from providers or facilities when necessary and provide 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. Answer and resolve portal tickets in a timely manner. Maintain accurate logs, track data trends and identify opportunities for process improvements. Exhibit a professional, pleasant and welcoming demeanor both in person and on the phone. Schedule 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. #J-18808-Ljbffr tango