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Remote Hca Utilization Review Jobs in Arizona (NOW HIRING)

Tango Care

Physician Reviewer (Remote)

Phoenix, AZ · On-site +1

Remote - flexible hours Essential Functions: * Perform focused real-time case reviews by reviewing ... Provides medical guidance and review activities for home health utilization management and medical ...

Upward Health

Nurse Care Manager

Phoenix, AZ · Remote

The Nurse Care Manager is a remote role responsible for reviewing electronic health records to gather pertinent clinical, behavioral health, social, and utilization information needed to build ...

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Remote Hca Utilization Review information

What is the difference between Remote Hca Utilization Review vs Remote Hca Case Manager?

AspectRemote Hca Utilization ReviewRemote Hca Case Manager
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalOften requires RN, social work, or case management certifications
Work EnvironmentPrimarily reviewing medical necessity and insurance coverage remotelyManaging patient cases, coordinating care, and discharge planning remotely
Employer & Industry UsageUsed by health insurance companies, healthcare providers, and utilization review organizationsEmployed by hospitals, insurance companies, and healthcare organizations

Remote Hca Utilization Review focuses on assessing medical necessity and insurance coverage, while Remote Hca Case Managers handle patient care coordination and discharge planning. Both roles require healthcare credentials and are integral to healthcare management, but they differ in daily responsibilities and focus areas.

How do I get into a remote HCA utilization review?

To become a remote HCA utilization review specialist, candidates typically need a healthcare background such as nursing or medical coding, along with knowledge of insurance policies and medical terminology. Relevant certifications like Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can improve job prospects. Employers often require prior experience in medical review or utilization management and proficiency with electronic health record (EHR) systems, with many roles offering flexible or remote schedules.

Is remote HCA utilization review work from home?

Remote HCA utilization review jobs are often performed from home, allowing reviewers to assess healthcare claims and authorizations remotely. These roles typically require familiarity with healthcare software, strong communication skills, and adherence to confidentiality standards. Many employers offer flexible or fully remote schedules for this position.

What are popular job titles related to Remote Hca Utilization Review jobs in Arizona?

For Remote Hca Utilization Review jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Remote Hca Utilization Review jobs in Arizona look for?

The top searched job categories for Remote Hca Utilization Review jobs in Arizona are:

What cities in Arizona are hiring for Remote Hca Utilization Review jobs?

Cities in Arizona with the most Remote Hca Utilization Review job openings:

Remote Hca Utilization Review jobs near you

Utilization Management (UM) Clinical Support Specialist (Remote)

Tango Care

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 8 days ago

Job description

Description
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 UM Clinical Support Specialist to join our growing team!
** This is a Non-Clinical role and Clinicians will not be considered **
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, review referrals for completeness, assisting reviewers with obtaining clinical information when needed, and supporting compliance, training, and appeal processes
Office Location:
  • Office located at 2415 E Camelback Road, Suite 700, Phoenix, AZ 85020
  • Remote (MST or PST time zone)

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 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.

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.

Knowledge and Experience:
  • 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.

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