Utilization Management (UM) Clinical Support Specialist (Remote)

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

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.