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Telligen · 3 weeks ago

Senior Review Coordinator RN (Remote in IA)

United States

Full-time

Remote

Mid, Senior Level

3+ years exp

Telligen is one of the most respected population health management organizations in the country. As a Senior Review Coordinator RN, you will conduct utilization review and medical management, train and mentor team members, and provide support to provider staff and physician reviewers.

Health Care

Culture & Values

No H1B

Responsibilities

You will perform prospective, concurrent, or retrospective utilization review/medical management for all services including appropriateness of quality of care based on contract, state, or URAC requirements

You will screen individual situations according to specific criteria to determine if care is appropriate

Refers cases that fail to meet screening criteria to peer reviewer

You will coordinate and participate in peer-to-peer review as warranted

You will serve as liaison between peer reviewer, provider, facility and/or subscriber

You will coordinate and participate in appeal process as directed by management

You will train or serve as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames

You will document review and special project results in workflow documentation system, ensuring data is accurate and timely

You will assist in compliance reporting

You will perform miscellaneous duties as assigned