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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 Director, Network Operations&nbsp;to join our growing team!The Network Operations Director is a key leadership role responsible for overseeing the entire provider credentialing process, optimizing operational workflows, implementing policies, and leading strategic initiatives within the Network Department. This role involves managing a dedicated team, coordinating communications, and ensuring accurate provider data configuration. Additionally, the Director will oversee provider onboarding and system enhancement requests, contributing to the ongoing transformation of network management operations. Successful candidates will bring a proven track record of effective leadership, strong compliance knowledge, and a focus on driving impactful enhancements in a dynamic environment.Job Responsibilities:<ul><li>Manage the credentialing team, providing guidance and oversight throughout the end-to-end provider credentialing process.</li><li>Ensure that provider credentials align with company compliance policies, Medicare guidelines, and State and Federal laws and regulations.</li><li>Review Network department workflows and proactively recommend improvements for enhanced operational efficiency and team performance.</li><li>Develop, implement, evaluate, and refine operational policies and procedures for the Network department, aligning with industry standards and best practices.</li><li>Plan, develop, and track projects related to operational enhancements, network related system implementations, and provider network strategic initiatives, assessing their impact on the Network Management function.</li><li>Lead the execution of strategic initiatives that contribute to the ongoing transformation of network management operations.</li><li>Oversee and coordinate the release of all Network-related communications, ensuring clear and consistent messaging.</li><li>Take charge of all provider data configuration activities, ensuring accuracy and alignment with organizational objectives.</li><li>Collaborate cross-departmentally to execute on provider configuration, process improvement, and strategic Network initiatives.</li><li>Oversee a centralized provider onboarding and system enhancement requests process.</li><li>Undertake network management assignments and other duties as directed by the management team.</li></ul>Ideal Candidate:<ul><li>Helps to create a challenging and fulfilling work environment while empowering others to deliver high quality customer service to both internal and external clients.</li><li>Excellent interpersonal, organizational and critical problem-solving skills.</li><li>Ability to build trust and assurances with various partners and stakeholders both externally and internally.</li><li>Project management skills with a focus on driving impactful enhancements.</li><li>Establish forward-looking goals and deliver results.</li><li>Proven experience in effectively leading teams managing credentialing processes and other network operations tasks.</li><li>Strong understanding of compliance policies, Medicare guidelines, and State and Federal laws and regulations.</li><li>Track record of optimizing workflows and implementing operational policies.</li><li>Project management skills with a focus on driving impactful enhancements.</li><li>Excellent written and verbal communication and presentation skills.</li><li>Ability to lead internal and external meetings.</li><li>Proficient in the use of Microsoft Office products (Word, Excel, Outlook and PowerPoint).</li></ul>Requirements:<ul><li>Minimum 5 years’ experience in a leadership role for a home health entity or minimum 3 years’ experience in a supervisor or management role for an insurance company.</li><li>Degree in healthcare administration, business administration or a closely related field preferred.</li><li>Minimum 2 years’ experience in a project manager role, preferred.</li><li>Must have a strong understanding of ancillary provider credentialing.</li><li>Must have a strong working knowledge of home care’s role in the post-acute care space.</li><li>Requires significant strategic experience working within home health, hospital setting, hospital system, association, insurance plan or benefit management organization.</li><li>Experience interacting, directing strategic planning, business planning and/or other organizational development activities.</li><li>Demonstrated management skills that include making effective and efficient decisions and prudent judgment to achieve long-range and short-term goals.</li><li>Knowledge of business processes that impact ancillary contracts.</li><li>Knowledge of ancillary contract reimbursement methodologies.</li><li>Ability to travel on a quarterly basis, at minimum.</li></ul>Continuous Education:Company personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, company personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All company personnel must attend mandatory educational programs.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

Director, Network Operations

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 Manager, Referral Management to join our growing team!As a key member of the Referral Management team, you will implement KPIs, mentor your supervisors, provide leadership development, and ensure SLAs and compliance metrics are met. Working closely with the Director of Referral Management and your supervisors, the Manager is responsible for onboarding new employees, coordinating with HR, liaising between HR and supervisors for HR issues, schedules and coverage, team building and employee recognition, monitoring of KPI’s, disciplinary actions, hiring and employment termination, and completion of root cause analysis.Office Location: * Remote *Responsibilities and Duties:Responsibilities of the Manager include, but are not limited to the following:Employee Management<ul><li>Address employee concerns and conflicts. Collaborate with HR as needed.</li><li>Manage professional development for employees.</li><li>Maintain department organization charts and employee directory.</li><li>Conduct performance and salary reviews in conjunction with Director, Referral Management.&nbsp;</li></ul><ul><li>Lead and manage assigned teams, providing guidance, mentorship, and support.</li><li>Collect, analyze, and measure employee quality and productivity data; review data for trends and gaps that may require additional employee support.</li><li>Perform monthly one-on-ones with each employee to deliver coaching and performance reviews.</li><li>Ensure appropriate scheduling of team members for day-to-day production coverage.</li><li>Working with QA and Training teams, support employee productivity and quality improvement; identify and support employee gaps.</li><li>Review daily productivity to ensure appropriate distribution of referrals, productivity concerns, and re-dissemination of referrals for timely completion.</li></ul>Collaboration and Communication:<ul><li>Collaborate with cross-functional teams to ensure quality-related requirements are understood and met.</li><li>Communicate quality-related metrics, trends, and issues to senior management.</li><li>Foster a positive and collaborative work environment to ensure effective teamwork and high morale within the teams.</li></ul>Process Improvement and Risk Management:<ul><li>Utilizes knowledge of healthcare regulations, such as HIPAA, CMS, FDA, or other applicable standards to process referrals within the seven day turnaround time frame.</li><li>Support identification of trends, participate in root cause analysis, and create corrective/preventive action plans to address identified issues.</li><li>Promote a culture of continuous improvement by driving quality initiatives and best practices across the organization.</li><li>Disseminate process changes live and redirect team as needed to achieve company goals.</li></ul>Qualifications:<ul><li>Must be at least 18 years of age</li><li>Home care / healthcare background is required</li><li>Bachelor’s Degree or equivalent work experience in management or&nbsp;</li><li>Must be able to travel to Phoenix office for onsite meetings throughout the year</li><li>Must be available for holiday and weekend coverage</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

Healthcare Manager (Referral Management)

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.

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)

Job OverviewTango is a leader in the home care health management industry and is preparing for significant growth! Tango is looking for an experienced healthcare contractor to act as our Contract Manager.Tango manages the home health benefit for major insurance plans with a focus on Medicare Advantage and managed Medicaid members. We review home health care referrals for appropriateness, then set up services with multiple agencies to provide the care needed for patients. On an ongoing basis, we provide review and oversight of clinical care and determine further authorizations. Our delegation agreements often include credentialing home health agencies and paying home health claims.&nbsp;This role will report into the Director of Contract Management to support the strategic growth and maintenance of our home health provider network. The Contract Manager is responsible for negotiating contracts for the expansion of our home health network and the ongoing management of the existing network across multiple geographies. In addition, the Contract Manager will provide leadership and oversight to assigned Contract Administrators to ensure effective execution of contracting activities and operational support. The Contract Manager will also be tasked with enhancing the existing network through value-driven contracting, provider performance, and relationship management.Responsibilities<ul><li>Negotiate fiscally responsible, fee for service, episodic and value-based contracts with language that supports Tango’s business model, payer agreements, and mission to provide high quality home health and post-acute services.</li><li>Provide leadership, mentorship, and oversight to assigned Contract Administrators to ensure quality, accuracy, and timely execution of contracting activities.</li><li>Ensure provider contracts meet Tango’s compliance policies, Medicare guidelines, State and Federal laws and regulations.</li><li>Negotiate and execute Letters of Agreement, Amendments to the Contracts and renegotiation requests.</li><li>Develop and report out key network performance indicators in a continual effort to achieve network optimization, adequacy, and other key network strategies.</li><li>Propose and execute on opportunities to improve network performance metrics.</li><li>Track and monitor value-based arrangements tied to provider contracts by building reports and working with the finance team.&nbsp;</li><li>Meet with contracted providers on a quarterly basis to review performance.</li><li>Assist with network builds across various geographies with support from credentialing, provider specialist(s), and management teams, as needed.</li><li>Work interdepartmentally to ensure contracts are loaded accurately and in a timely manner.</li><li>Identify and propose opportunities to better streamline existing processes.</li><li>Recruit and educate out of network providers on Tango’s business model in an effort to create greater access to existing markets.</li><li>Carry out network management assignments and other duties as directed by the management team.</li><li>Provide support and guidance to internal teams on contract-related items.</li><li>Review and analyze contract terms, identify potential risks and opportunities.</li></ul>Ideal Candidate<ul><li>Excellent interpersonal skills</li><li>Highly organized with strong written and verbal communication skills</li><li>Well versed in navigating the nuances of ancillary provider contract negotiations&nbsp;</li><li>Some experience negotiating value driven payment concepts.</li><li>Ability to build trust and assurances with various partners and stakeholders both externally and internally.&nbsp;</li><li>Proven ability to effectively problem solve and diffuse difficult situations in a timely manner</li><li>Natural curiosity to learn and grow within a fast-paced organization.&nbsp;</li><li>Proficient in Microsoft Excel and navigating large data files.</li><li>General understanding of value-based metrics and gap closures</li><li>Experience building and monitoring reports.</li><li>Excellent organizational and time management skills</li><li>Strong attention to detail</li></ul>Education<ul><li>Requires a BA/BS&nbsp;</li></ul><ul><li>Masters preferred.</li></ul>Requirements<ul><li>Minimum 3 years’ experience in an ancillary provider contracting role on a state level; multi-state level preferred.</li><li>Must have knowledge of home health agency contract structure.&nbsp;</li><li>Must have knowledge of PDGM payment modeling.</li><li>Must have experience with alternative payment models and value-based arrangements.</li><li>Must have a strong understanding of home health agency credentialing process.</li><li>Must have a strong working knowledge of home care’s role in the post-acute care space.</li><li>Ability to travel on a quarterly basis, at minimum. </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.

Manager, Contract (Remote)

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 Physician Reviewer to join our growing team on a per diem basis!The Physician Reviewer is in a utilization management reviewer role at tango – providing UM case reviews, peer to peer calls/conversations and consultations in real-time; assisting as a resource with functional areas such as utilization management/review, provider relations and communications, and working with physicians to provide education, peer to peer reviews and support.Office Location:<ul><li>Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020</li><li>Remote only – flexible hours (preferred availability during work hours 9:00am – 6:00pm).&nbsp; </li><li>Must be licensed in TN</li></ul>Essential Functions:<ul><li>Perform focused real-time case reviews by reviewing the information in the software system(s).</li><li>Applies medical judgement and pertinent evidence based clinical guidelines to determine medical necessity on pre-service, concurrent, and retroactive and claims reviews of medical home health services.</li><li>Reviews Potential Quality Issues (PQIs).</li><li>The Physician Reviewer will provide quality reviews that address the individual needs of the member, align with medical evidence guidelines, and meet compliance requirements.</li><li>The Physician Reviewer will identify and appropriately document areas of inappropriate utilization of resources.&nbsp;</li><li>Participates in inter-rater review</li><li>Perform Peer-to-Peer case discussions with payer medical directors, PCP’s, hospitalists and</li><li>The Physician Reviewer must maintain positive relationships with a variety of external and internal stakeholders, including working closely with primary care physicians, specialists, hospitalist physicians, nursing, therapists, and staff, participate in interdisciplinary team meetings.</li><li>Provides medical guidance and review activities for home health utilization management and medical quality improvement activities and programs in accordance with health plan, regulatory, state, corporate, and NCQA accreditation requirements.</li><li>Attend and participate as assigned quarterly UM, QM and Compliance Committee</li><li>Provide input on clinical content for specific</li><li>Evaluate potential quality of care concerns as</li><li>Assist in developing and reviewing policies as requested/</li><li>Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice and/or acute care readmissions to improve the quality and cost of care.</li><li>Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality for home care</li><li>Participate in all aspects of regulatory compliance related to health services functions at</li><li>The physician Reviewer must function within the virtual environment and be able to work individually, while working collaboratively with the clinical/medical management team.</li></ul>Qualifications:<ul><li>MD or DO license in good standing and no restrictions in state where UM reviews are conducted</li><li>Board certified preferable in a primary care specialty (Internal Medicine, gerontology, Family Medicine, Physical Medicine and Rehabilitation).</li><li>Must be an actively practicing physician with 10+ years’</li><li>Course work in the areas of Health Administration, Health Financing and Insurance is helpful</li><li>Board Certification through American Board Medical Specialties</li></ul>Knowledge and Experience:<ul><li>3+ years of health plan or IPA experience conducting UM Authorization and determination reviews preferred</li><li>Peer-to-Peer meeting experience</li><li>Medicare Advantage, Medicare and Medicaid experience</li><li>Must be proficient and have good computer and technology skills</li><li>CMS Chapter 7 Home Health knowledge is a plus</li><li>Supports a culture of continuous quality improvement</li><li>2+ years Milliman Care Guidelines or InterQual experience</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.

Physician Reviewer - TN (Remote)

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 Physician Reviewer to join our growing team on a per diem basis!The Physician Reviewer is in a utilization management reviewer role at tango – providing UM case reviews, peer to peer calls/conversations and consultations in real-time; assisting as a resource with functional areas such as utilization management/review, provider relations and communications, and working with physicians to provide education, peer to peer reviews and support.Office Location:<ul><li>Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020</li><li>Remote only – flexible hours (preferred availability during work hours 9:00am – 6:00pm).&nbsp; </li><li>Must be licensed in OR</li></ul>Essential Functions:<ul><li>Perform focused real-time case reviews by reviewing the information in the software system(s).</li><li>Applies medical judgement and pertinent evidence based clinical guidelines to determine medical necessity on pre-service, concurrent, and retroactive and claims reviews of medical home health services.</li><li>Reviews Potential Quality Issues (PQIs).</li><li>The Physician Reviewer will provide quality reviews that address the individual needs of the member, align with medical evidence guidelines, and meet compliance requirements.</li><li>The Physician Reviewer will identify and appropriately document areas of inappropriate utilization of resources.&nbsp;</li><li>Participates in inter-rater review</li><li>Perform Peer-to-Peer case discussions with payer medical directors, PCP’s, hospitalists and</li><li>The Physician Reviewer must maintain positive relationships with a variety of external and internal stakeholders, including working closely with primary care physicians, specialists, hospitalist physicians, nursing, therapists, and staff, participate in interdisciplinary team meetings.</li><li>Provides medical guidance and review activities for home health utilization management and medical quality improvement activities and programs in accordance with health plan, regulatory, state, corporate, and NCQA accreditation requirements.</li><li>Attend and participate as assigned quarterly UM, QM and Compliance Committee</li><li>Provide input on clinical content for specific</li><li>Evaluate potential quality of care concerns as</li><li>Assist in developing and reviewing policies as requested/</li><li>Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice and/or acute care readmissions to improve the quality and cost of care.</li><li>Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality for home care</li><li>Participate in all aspects of regulatory compliance related to health services functions at</li><li>The physician Reviewer must function within the virtual environment and be able to work individually, while working collaboratively with the clinical/medical management team.</li></ul>Qualifications:<ul><li>MD or DO license in good standing and no restrictions in state where UM reviews are conducted</li><li>Board certified preferable in a primary care specialty (Internal Medicine, gerontology, Family Medicine, Physical Medicine and Rehabilitation).</li><li>Must be an actively practicing physician with 10+ years’</li><li>Course work in the areas of Health Administration, Health Financing and Insurance is helpful</li><li>Board Certification through American Board Medical Specialties</li></ul>Knowledge and Experience:<ul><li>3+ years of health plan or IPA experience conducting UM Authorization and determination reviews preferred</li><li>Peer-to-Peer meeting experience</li><li>Medicare Advantage, Medicare and Medicaid experience</li><li>Must be proficient and have good computer and technology skills</li><li>CMS Chapter 7 Home Health knowledge is a plus</li><li>Supports a culture of continuous quality improvement</li><li>2+ years Milliman Care Guidelines or InterQual experience</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.

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