Senior Review Coordinator

Senior Review Coordinator As a Senior Review Coordinator, you will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on requested topics. In addition, you may provide technical assistance, medical record review, and support to provider staff and physician reviewers. You will review written and verbal clinical information against evidence-based guidelines to determine the medical necessity of procedures.  Hours: 9:30am to 6:00pm central time. The hybrid schedule will require in-office work during training and 1 day per month in the West Des Moines, IA office.

Essential Functions

• Perform prospective, continued stay, and retrospective utilization/medical management reviews to include quality of care based on contractual and state standards. 
• Perform onsite as well as electronic health record reviews to determine the appropriateness of care. 
• Refer cases that fail to meet screening criteria to peer reviewers.
• Coordinate and participate in peer-to-peer reviews as warranted.
• Serve as a liaison between the peer reviewer, provider, facility, and/or subscriber.
• Coordinate and participate in the appeal process as appropriate.
• Document review activity in data management systems, ensuring data is accurate and timely.
• Assist in compliance reporting tasks and quality assurance reviews. 

Requirements

• Compact RN License.
• 3 – 5 years of recent experience working in a clinical environment
• Prior UM experience and experience with MCG criteria are preferred
• Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems
• Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential
• Good written and oral communication skills are required
• Med/Surg and/or ICU hospital experience is preferred
• Up to 5% local and overnight travel - valid driver's license required
• Knowledge or URAC standards preferred
• We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories

COMMITMENT TO SAFETYAs part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination) Who We Are: Telligen is one of the most respected population health management organizations in the country.  We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions. Our business is our people and we’re looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us Are you Ready? We’re on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.  Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.Ingenuity: We’re a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we’re all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away! Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.  Thank you for your interest in Telligen!Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Telligen does not accept 3rd party solicitations from outside staffing firms.