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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, Utilization Management&nbsp;to join our growing team!&nbsp;Position Description:The Supervisor of Utilization Management (UM) oversees team leads and ensures the overall management of referrals to support smooth transitions of care into the home health setting. This role is responsible for team productivity, performance metrics, and effective collaboration with internal departments. The Supervisor also serves as a clinical resource and ensures that all utilization processes align with company policies, payer requirements, and quality standards.Essential Functions:1.Mentor and coach team members to further develop competencies.2.Lead by example and model behaviors aligned with company values.3.Maintain an open-door policy to encourage communication and improve staff engagement.4.Partner with the Clinical Educator to train new staff, ensuring adherence to payer and company procedures and performance standards.5.Collaborate with team leads to monitor, coach, and measure team performance, including productivity, quality, and attendance.6.Serve as a clinical resource to non-clinical team members.7.&nbsp;Educate direct reports on all aspects of the pre-authorization and concurrent review process.8.Schedule and lead monthly team meetings to communicate updates, audit results, and process improvements.9.Ensure timely and accurate processing of delegated and non-delegated home health contracts.10.Support plan requirements related to turnaround times and compliance.11.Manage work queues, monitor key metrics, and ensure workload distribution.12.Collaborate with the Sr. Supervisor to plan staffing levels, monitor labor utilization, and manage overtime.13.Participate in hiring, performance reviews, improvement plans, and disciplinary actions as directed.14.Complete cases weekly to maintain “super-user” knowledge of processes and software.15.Demonstrate knowledge of home health care and specialty programs in all communications with referral sources and healthcare partners.16.Oversee workflow coordination to ensure efficient and timely operations.17.Partner with intake, compliance, claims, network, quality, and other departments to ensure services meet regulatory and contractual requirements.18.Ensure smooth onboarding of new payer contracts.19.Provide excellent customer service in all communications with internal and external stakeholders.20.&nbsp;Escalate administrative oversight issues related to clinical staff (RNs, PTs, OTs, SLPs, etc.) to the Sr. Supervisor as appropriate.21.Perform other duties as assigned.Office Location:<ul><li>Remote</li></ul>Qualifications:<ul><li>Licensed clinician: RN with no restrictions.</li><li>Ability to obtain additional state licensure as required.</li><li>Prior home health experience preferred.</li><li>Minimum of 10 years of clinical experience.</li><li>Previous supervisory experience required.</li><li>Strong ability to teach, coach, and apply adult learning techniques.</li><li>Self-directed, motivated, and able to work independently under the Sr. Supervisors guidance.</li><li>Strong verbal, written, and interpersonal communication skills.</li><li>Effective problem-solving skills with ability to resolve complex issues.</li><li>Skilled in adapting to procedural and organizational changes.</li><li>Ability to read, analyze, and interpret technical procedures, regulatory documents, and payer contracts.</li><li>Experience presenting to and collaborating with physicians, managers, payers, and external stakeholders.</li></ul>Knowledge and Experience:<ul><li>Extensive knowledge of the post-acute continuum of care.</li><li>Expertise in CMS Chapter 7 guidelines and Milliman criteria.</li><li>Strong proficiency with Microsoft Office (Outlook, Word, Excel, SharePoint), Adobe, and medical management systems.</li><li>&nbsp;Ability to work in a fast-paced environment and manage competing priorities.</li></ul>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.

tango

Supervisor, Utilization Management (Remote) (RN)

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&nbsp;Utilization Management Therapist Reviewer to join our growing team!&nbsp; **Preferred licensure is MI or TN**Position Description: Therapist Reviewers are responsible for conducting re-authorization/certification and authorization activities for therapy home health services, by utilizing appropriate company policies, Medicare Chapter 7, Milliman Care Guidelines, and clinical department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of physical, occupational therapy and speech language pathology visits to ensure quality member outcomes, and to optimize member benefits.Essential Functions:<ul><li>Responsible for the review of medical records, including more complex cases, to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) are medically necessary.</li><li>Provides and/or facilitates clinical management and/or other related activities and serves as a resource to other team members while demonstrating fiscal responsibility and maintaining the highest standards of care and ensuring compliance with all policies, procedures, and regulatory requirements. Promotes interdisciplinary health plan consumers/beneficiaries’ care planning and supports questions from nurses in addition to agency, physician, member/family calls, etc.</li><li>Applies professional therapy, NCQA standards, CMS and Medicaid government regulation and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes, and operational unit goals to ensure customer satisfaction.</li><li>Maintains knowledge of regulations and requirements through review of current regulations and/or policies. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with regulations and requirements. Research and obtain additional data, consult with clinical reviewers and medical directors, when necessary.</li><li>Acts as a resource for internal and external customers. Participates in or leads intradepartmental teams, projects, and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within the required timeframes.</li><li>Periodic Weekend and Holiday Rotation based on business needs</li><li>Collaborate with colleagues to enhance their understanding of key considerations when reviewing therapy-related approvals and denials, including required documentation and criteria.</li><li>Develops and maintains positive customer relations and coordinates with various departments within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</li><li>Other duties as requested</li></ul>Office Location:<ul><li>Remote</li></ul>Qualifications:<ul><li>Requires graduate of a college level program in physical therapy, occupational therapy or speech language pathology.</li><li>Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.</li><li>Current active unrestricted license or certification as a PT, OT or SLP required in applicable states.</li><li>Working knowledge of home care process and CMS regulatory and federal requirements.</li><li>Ability to exercise initiative and independent judgement.</li></ul>Knowledge and Experience:<ul><li>Requires extensive knowledge in the areas of home health community-based physical, occupational therapy and speech language pathology services and utilization/case management.</li><li>NCQA and URAC knowledge is helpful.</li><li>Excellent organizational, human relations, and communication skills are required to maintain good rapport and effective working relationships with internal and external customers.</li><li>3 years of home health experience is preferred.</li><li>Managed care, utilization review/management or case management experience preferred</li><li>Computer skills such as MS Office products - Outlook, Excel, Word, Adobe, and the ability to work within multiple medical management systems</li></ul>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

Utilization Management Therapist Reviewer (Remote) MI or TN

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&nbsp;&nbsp;to join our growing team!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:<ul><li>Assists in mentoring, reinforcement of training, and development of utilization management/review staff.</li><li>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.</li><li>Monitors PTO and coordinates with other department leads, supervisor and management team for coverage.</li><li>Responds to QIO appeals in a timely manner and write a DENC to send to member.</li><li>Provides support, guidance, leadership, and motivation to promote maximum performance of team members</li><li>Collaborates with supervisor in establishing performance development plans and conducting performance reviews</li><li>Collaborates with educator/trainer to establish and ensure achievement of office/unit customer service, utilization patterns, productivity, quality, and financial goals</li><li>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</li><li>Reinforces pertinent changes in policy/process, regulatory mandates, or business functions; acts as a resource.</li><li>Other clinical and team lead duties as required.</li><li>Responds to call center agency/provider/member questions/concerns promptly</li><li>Completes case reviews at a minimum of 50% of UM reviewer established goals</li><li>Communicates/defers to director on administrative oversight of RNs, PTs, OTs, and other disciplines as needed</li></ul>Office Location:<ul><li>Remote</li></ul>Qualifications:<ul><li>Working knowledge of home care and utilization management</li><li>Ability to exercise initiative and sound clinical judgement</li><li>Active unrestricted RN license required in states&nbsp;tango conducts business</li></ul>Knowledge and Experience:<ul><li>Five (5) years of clinical practice experience or equivalent combination of healthcare and supervisory experience.</li><li>Strong knowledge of utilization review practices</li><li>PC literate, including Microsoft Office products, Outlook, Excel, Word, Adobe, and the ability to work within multiple medical management software systems</li><li>Leadership/ motivational skills</li><li>Good organizational skills</li><li>Excellent interpersonal skills</li><li>Ability to work in a team environment</li><li>Ability to meet or exceed Performance Competencies and Productivity Standards</li></ul>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.

Lead, Utilization Review Team (RN)

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with renal disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. We are currently seeking an ASC Clinical Manager to join our Team. To learn more about us, please visit our website: <a href="http://www.akdhc.com" target="_blank">www.akdhc.com</a>Infection Prevention Quality Access Center NurseSummary:&nbsp;Evaluates quality of patient care and patient outcomes as they relate to healthcare-associated infections; collects, prepares and analyzes healthcare-associated infection data; presents infection data and makes recommendations for actions; monitors employee compliance in use of barriers and infection prevention measures; prepares and presents educational offerings for the staff; serves as a resource to all departments and personnel.Essential Duties and Responsibilities include the following. Other duties may be assigned.&nbsp;<ul><li>Does on-going monitoring of healthcare-associated infections.&nbsp;</li><li>Identifies infection prevention problems and makes recommendations for corrective actions.&nbsp;</li><li>Prepares the agenda for the Infection Prevention Committee.&nbsp;</li><li>Monitors infection prevention practices and employee compliance.&nbsp;</li><li>Serves as a resource for all departments and personnel.&nbsp;</li><li>Initiates, reviews, and revises infection prevention policies and procedures.&nbsp;</li><li>Conducts outbreak investigation and initiates control measures.&nbsp;</li><li>Reports communicable diseases to the state as required by law.&nbsp;</li><li>Provides educational offerings for orientation and on-going in-services.&nbsp;</li><li>Consults with department management and physicians as needed to improve care.&nbsp;</li><li>Initiates follow-up on employee/patient exposures to communicable diseases.&nbsp;</li><li>Participates in Quality Assurance (QA) program and activities.&nbsp;</li><li>Participates in short and long range planning for the infection prevention department.&nbsp;</li><li>Performs other duties as directed.&nbsp;</li><li>Complies with current OSHA guidelines.&nbsp;</li><li>Logs and PM inspections by providing support and review of logs and PM equipment and building inspections.&nbsp;</li><li>Quality Processes preparation, peer reviews, medication safety, EOC rounds, Hospitalization.&nbsp;</li><li>AAAHC, AZDHS, AORN, APIC, CMS, CDC, NHSN, ASDIN Maintain status with regulatory guidelines impacting policies and procedures of the ASC.&nbsp;</li><li>Policy and Procedures write, and rewrite policies and procedures as needed.&nbsp;</li><li>Governing Body Minutes annually and more frequently with any changes in P&amp;P.</li></ul>Supervisory Responsibilities:&nbsp;This job has no supervisory responsibilities.Competencies To perform the job successfully, an individual should demonstrate the following competencies:<ul><li>Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.</li><li>Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.</li><li>Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.</li><li>Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service ; Responds to requests for service and assistance; Meets commitments.</li><li>Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.</li><li>Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.</li><li>Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.</li><li>Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.</li><li>Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.</li><li>Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.</li><li>Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.</li><li>Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths &amp; weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.</li><li>Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.</li><li>Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.</li><li>Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.</li><li>Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.</li><li>Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.</li><li>Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.</li><li>Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.</li><li>Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.</li></ul>Qualifications:&nbsp;To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:<ul><li>Education/Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school. Experience in Quality Assessment Performance Improvement (QAPI), and Fire and Safety Programs.</li><li>Language Ability:&nbsp;Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.</li><li>Math Ability:&nbsp;Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.</li><li>Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.</li><li>Computer Skills: To perform this job successfully, an individual should have some basic computer knowledge.</li><li>Certificates and Licenses:&nbsp;Current Arizona Registered Nurse License, current certification in Basic Life Support and current ACLS certification.</li></ul>Work Environment:&nbsp;The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly exposed to risk of radiation. The noise level in the work environment is usually moderate.Physical Demands:&nbsp;The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must regularly lift and /or move up to 50 pounds. While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl and talk or hear.Key Qualifications:&nbsp;<ul><li>Registered Nurse (RN) with an active license&nbsp;</li><li>Minimum of 5 years of experience in healthcare quality management and reporting.&nbsp;</li><li>Strong understanding of quality measures.&nbsp;</li><li>Excellent analytical, organizational, and communication skills.&nbsp;</li><li>Experience with electronic health records systems.&nbsp;</li><li>Ability to travel up to 50%</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits, and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Insperity

Infection Prevention Quality Access Center Nurse

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with Chronic Kidney disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. To learn more about us, please visit our website: <a href="http://www.akdhc.com" target="_blank">www.akdhc.com</a>.Registered Nurse (RN) - AKDHC Phoenix Access Surgery CenterThis RN provides pre-operative, intra-operative, and post-operative care to patients per physician’s orders. Assists during interventional and surgical operating room procedures.Essential Duties and Responsibilities:<ul><li>Prepares the patient for the medical procedure according to established guidelines.</li><li>Ensures documented informed consent has been received from the patient prior to administering sedation.&nbsp;</li><li>Administers medication as needed.&nbsp;</li><li>Administers IV therapy and other therapeutic and diagnostic measures.&nbsp;</li><li>Facilitates patient transfer to EMS and hospital facilities.&nbsp;</li><li>Expedites timely and smooth flow of patients through the Access Center.&nbsp;</li><li>Completes patient assessments for potential problems with patency and other indicators of dialysis access.&nbsp;</li><li>Maintains accurate and complete medical records.&nbsp;</li><li>Provides patient education and instructions on home care and documents patient’s understanding.&nbsp;</li><li>Uses equipment standard to the profession, such as cardiac monitors, oxygen administration systems, and stethoscopes.&nbsp;</li><li>Performs crash cart maintenance and defibrillator checks.&nbsp;</li><li>Enters pertinent information in the computer system designed for statistical analysis, research, and patient follow-up.&nbsp;</li><li>Maintains Infection Logbook.&nbsp;</li><li>Assists with maintaining adequate supply and medication inventory.&nbsp;</li><li>Complies with current OSHA guidelines.&nbsp;</li><li>Maintains the patient's right to privacy.&nbsp;</li><li>Participates in the Quality Assurance (QA) Program.</li></ul>Qualifications/Skills:<ul><li>Associate's degree (A. A.) or equivalent from two-year college or technical school&nbsp;</li><li>Two years of acute or critical care experience is preferred in addition to experience with Conscious Sedation.&nbsp;</li><li>Current Arizona Registered Nurse License, current certification in Basic Life Support, and current ACLS certification.</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

5 Nursing Jobs in Mesa, AZ, USA