Senior Review Coordinator RN

As a Senior Review Coordinator, you will will be responsible for conducting utilization review/medical management for all services including training and mentoring other team members and performing preliminary research on requested topics. Provide technical assistance, medical record review and support to provider staff and physician reviewers.Typical hours will be M- F 8:00 am to 4:30 pm Central Time.

Essential Functions

• Performs prospective, concurrent or retrospective utilization review/medical management for all services including appropriateness of quality of care based on contract, state, or URAC requirements. Screens individual situations according to specific criteria to determine if care is appropriate. Refers cases that fail to meet screening criteria to peer reviewer. Coordinates and participates in peer-to-peer review as warranted. Serves as liaison between peer reviewer, provider, facility and/or subscriber. Coordinates and participates in appeal process as directed by management.
• Trains or serves as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames.
• Documents review and special project results in workflow documentation system, ensuring data is accurate and timely.
• Assists in compliance reporting.
• Performs miscellaneous duties as assigned.

Requirements

• Located in Council Bluffs or surrounding areas with an ability to be co-located with our customers if required.
• Four-year degree in health care or two- or three-year degree in nursing or related field and/or equivalent training and/or experience; 3 – 5 years recent experience working in a clinical environment; specific contracts may require valid, current and appropriate state RN license or certification directly relevant to the type of review performed.
• The successful candidate(s) will show an ability to contribute to a positive team environment and demonstrate an ability to perform high quality work efficiently.
• Have the ability to travel 5% local and/or overnight travel.
• Utilization Management experience highly preferred
• HCBS waiver experience highly preferred
• Knowledge of URAC standards preferred.

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.
While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination).Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers, and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work aut