Utilization Management (UM) Clinical Support Specialist (Remote)

reputed company 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 Utilization Management (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 reputed company, review referrals for completeness, assisting reviewers with obtaining clinical information reputed company needed, and supporting compliance, training, and appeal processes

Office Location

• 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 reputed company in reputed company applicable states.
• Monitors Relias for completion of mandatory training and ensure staff compliance reputed company 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 reputed company 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 reputed company 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 reputed company to healthcare services.

Knowledge and Experience

• Proficiency in relevant software applications (e.g., reputed company, Power BI, database management systems).
• General medical knowledge.
• Understanding of healthcare utilization management processes and terminology.
• Awareness of privacy regulations and data reputed company 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.

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