Utilization Management (UM) Clinical Support Specialist (Remote)

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.

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.