[Hiring] Utilization Management Clinical Support Specialist @Professional Health Care Network

Role Description

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, reviewing 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 16th 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 manages 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 ensures 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, inquiries, 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.
• Assists UM reviewers with administrative tasks in relation to the PA/RA/Appeals process.
• Assists 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.

Requirements

• 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.

Company Description

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.