Lead, Utilization Review Team (Remote)

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 Lead, Utilization Review Team  to join our growing team! 

This is a Tuesday through Saturday shift for the selected candidate

Position Description:

To provide services for dedicated health plan accounts and members; to ensure the efficient, cost effective, and high quality delivery of utilization management/review service by supporting a team of nurses; to oversee the management of home health cases worked by review nurses; to oversee individual and overall results/outcomes of cases within their scope of responsibilities; and to ensure customer satisfaction through the provision of cost effective and high quality utilization review service that meets their needs.

Essential Functions:

1. Assists in mentoring, reinforcement of training, and development of utilization management/review staff.
2. Oversees a team ensuring utilization management services are delivered promptly, cost effectively, courteously, and according to legal and contract requirements, operational, and quality assurance standards.
3. Monitors PTO and coordinates with other department leads, supervisor and management team for coverage.
4. Responds to QIO appeals in a timely manner and write a DENC to send to member.
5. Provides support, guidance, leadership, and motivation to promote maximum performance of team members
6. Collaborates with supervisor in establishing performance development plans and conducting performance reviews
7. Collaborates with educator/trainer to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality, and financial goals
8. Ensures that staff adheres to quality assurance and productivity standards: assists supervisor in evaluating customer service utilization patterns, productivity, quality, and financial results ensuring that service delivery is within parameters defined by the company
9. Reinforces pertinent changes in policy/process, regulatory mandates, or business functions; acts as a resource.
10. Other clinical and team lead duties as required.
11. Responds to call center agency/provider/member questions/concerns promptly
12. Completes case reviews at a minimum of 50% of UM reviewer established goals
13. Communicates/defers to director on administrative oversight of RNs, PTs, OTs, and other disciplines as needed

Office Location:

• Remote

Qualifications:

• Working knowledge of home care and utilization management
• Ability to exercise initiative and sound clinical judgement
• Active unrestricted RN license required in states tango conducts business

Knowledge and Experience:

• Five (5) years of clinical practice experience or equivalent combination of healthcare and supervisory experience.
• Strong knowledge of utilization review practices
• PC literate, including Microsoft Office products, Outlook, Excel, Word, Adobe, and the ability to work within multiple medical management software systems
• Leadership/ motivational skills
• Good organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies and Productivity Standards

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.