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Remote Psychiatric Utilization Review Jobs in Arizona

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 Psychiatric Utilization Review information

What is a remote psychiatric utilization review?

A Remote Psychiatric Utilization Review position involves evaluating mental health treatment plans and services to ensure they are medically necessary and meet insurance or regulatory guidelines. Professionals in this role typically review clinical documentation, assess the appropriateness of care, and make recommendations regarding the coverage of psychiatric services, all while working remotely. They collaborate with healthcare providers, insurance companies, and sometimes patients, to facilitate quality care and manage costs. Strong knowledge of mental health diagnoses, treatment protocols, and insurance policies is essential for success in this position.

What are the key skills and qualifications needed to thrive as a remote psychiatric utilization review specialist?

To thrive as a Remote Psychiatric Utilization Review specialist, you need a clinical background in nursing, social work, or mental health counseling, typically with relevant licensure (such as RN, LCSW, or LPC) and experience in psychiatric care. Familiarity with utilization review platforms, electronic health records (EHRs), and managed care systems is essential, along with certifications like CCM (Certified Case Manager) being advantageous. Strong analytical thinking, attention to detail, and effective verbal and written communication skills are crucial for evaluating cases and coordinating with providers. These competencies ensure accurate assessments, compliance with regulations, and optimal patient outcomes while managing costs in a remote work environment.

What are some common challenges faced by professionals in remote psychiatric utilization review roles, and how can they be addressed?

Professionals in Remote Psychiatric Utilization Review often encounter challenges such as interpreting clinical documentation remotely, ensuring timely case reviews, and maintaining effective communication with providers and insurance companies. Staying organized and developing strong time-management skills are key to managing caseloads efficiently. Regularly participating in team meetings and leveraging secure digital communication tools can help bridge the gap between remote team members and facilitate collaboration. Continuous education on evolving mental health regulations and payer guidelines is also essential to remain effective in the role.

What is the difference between Remote Psychiatric Utilization Review vs Remote Mental Health Case Manager?

AspectRemote Psychiatric Utilization ReviewRemote Mental Health Case Manager
CredentialsLicensed Psychiatrist, Psychologist, or Certified Utilization Review ProfessionalLicensed Clinical Social Worker, Mental Health Counselor, or Case Management Certification
Work EnvironmentReviewing medical records, insurance documentation, and making utilization decisions remotelyCoordinating care, assessing client needs, and providing support remotely
Employer & Industry UsageInsurance companies, health plans, and utilization review organizationsHealthcare providers, community agencies, and insurance companies

Remote Psychiatric Utilization Review focuses on evaluating medical necessity for psychiatric services, often within insurance and healthcare organizations. In contrast, Remote Mental Health Case Managers actively coordinate and support patient care. Both roles require mental health credentials but differ in daily tasks and focus areas.

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

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

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

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

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

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

Remote Psychiatric Utilization Review jobs near you

Utilization Management (UM) Clinical Support Specialist (Remote)

Tango Care

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 6 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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