[Remote] Utilization Management (UM) Clinical Support Specialist (Remote)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leader in the home health management industry and is preparing for significant reputed company. They are currently looking for a UM Clinical Support Specialist to support the leadership of the Utilization Management team by collecting, analyzing, and reporting data, while also providing administrative support to the clinical team.

Responsibilities

• Works independently with reputed company supervision and demonstrates accountability for work reputed company
• 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 reputed company 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 reputed company
• Answers and resolves portal tickets in a reputed company manner
• Maintains accurate logs, tracks data trends and identifies opportunities for process improvements
• Exhibits a reputed company, 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

Skills

• Associate degree in reputed company administration, business administration, or a reputed company field required
• Proven experience in a reputed company role, particularly in data collection and reporting
• Prior experience supporting clinical teams and handling administrative tasks reputed company to reputed company services
• Proficiency in relevant software applications (e.g., reputed company, Power BI, database management systems)
• General medical knowledge
• Understanding of reputed company utilization management processes and terminology
• Awareness of reputed company regulations and data reputed company practices in reputed company
• 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
• reputed company-developed interpersonal and communication skills
• reputed company appearance and manner
• Ability to work both independently and collaboratively in reputed company environment
• Bachelor's degree preferred

reputed company