Remote Prior Authorization Jobs in Arizona (NOW HIRING)

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 Supervisor to join our growing Utilization Management team!

Position Description:

The Supervisor oversees the team leads and is responsible for overall management of referrals to ensure a smooth transition of care to the home health setting. This position is responsible for managing team productivity, metrics, and collaboration with tango internal departments on policy and procedures and outcomes.

Essential Functions:

1. Mentors and coaches team members to further develop competencies.
2. Leads by example and models behaviors that are consistent with the company's values.
3. Maintains an open-door policy to maintain/encourage communicate with team and improve staff engagement.
4. In collaboration with Clinical Nurse Educator, responsible for the training of new staff to ensure referral reviews adhere to tango's and payer established procedures and meets quality performance standards.
5. In collaboration with team leads, coaches, monitors, and measures the performance of individual contributors, including but not limited to managing productivity, quality, time, and attendance.
6. Provide clinical knowledge and act as a clinical resource to non-clinical team.
7. Educate and guide direct reports on all aspects of the pre-authorization and concurrent review process.
8. Schedules and leads monthly team meetings to communicate changes or enhancements to process, new contracts, audit results, and any other information the team requires to function efficiently and effectively.
9. Participates in team meetings to maintain communication and improve employee engagement.
10. Ensure delegated and non-delegated contracts for members needing home health services are processed correctly.
11. Support all plan expectations related to turn-around-times.
12. Manages key metrics and work queues assigned.
13. In collaboration with the Director plans and monitors appropriate staffing levels and utilization of labor, including overtime.
14. In collaborations with team leads prepares and delivers input for performance appraisal for staff.
15. In collaboration with Director provides input on employee reviews, hiring and termination, employee improvement plans and assignment of daily duties.
16. Completes cases weekly to maintain super- user knowledge of process and tango software.
17. Demonstrates knowledge of home care processes and all specialty programs in all communications with referral sources and health care partners.
18. Facilitates and ensures quality, coordinated and timely clinical services as the patient moves across the continuum of care.
19. Oversees and assists with coordination of workflow processes.
20. Demonstrates knowledge of home care processes in all communications with referral sources.
21. Works collaboratively with intake, compliance, claims, network, quality and other internal departments to ensure and facilitate the home care services comply will all regulatory and agency contract guidelines as well as onboarding new contracts as needed.
22. Communicates effectively with all internal and external contacts utilizing excellence in customer service skills.
23. To ensure compliance with payer plan contracts and company policies and procedures while educating to the goal of optimal patient and company outcomes.
24. Communicates/defers to director on administrative oversight of RNs, PTs, OTs, and other disciplines as needed.
25. Other duties as assigned.

Office Location:

Remote

Office located at 2415 E Camelback Road, Suite 700 Phoenix, AZ 85016

The position is a full-time, exempt role. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business needs including weekends and holiday.

Qualifications:

• Current Arizona state licensure as a licensed practical nurse (LPN/LVN) or registered nurse (RN) with no restrictions.
• Ability to obtain additional licenses in states the company does business in.
• Must be able to teach and coach in various adult learning techniques.
• Must have the ability to be self-directed, motivated, and work with limited supervision under the Manager.
• Must have excellent verbal and written communications and excellent customer service skills.
• Must be able to communicate effectively with all members of the team.
• Must have the ability to grasp and adapt to changes in procedure and process.
• Must have the ability to effectively resolve complex issues.
• Prior experience in home health required.
• Ability to read, analyze, and interpret technical procedures, review documents, or contract regulations.
• Ability to respond to questions from groups of managers, physicians, clients, customers, and the payers.
• Communicates professionally with internal and external stakeholders.

Knowledge and Experience:

• Extensive knowledge and experience in the post-acute continuum.
• Previous supervisory experience required.
• Excellent communication, interpersonal, computer and customer service skills.
• Ability to work in a fast-paced environment and readily adapt to organizational change.
• Minimum 10 years clinical experience.
• Performs other duties as assigned.
• Must be knowledgeable in use and comprehension of Chapter 7 CMS guidelines and Milliman.
• Computer skills such as MS Office products - Outlook, Share Point, Excel, Word, Adobe, and the ability to toggle within multiple medical management systems

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.