Senior Review Coordinator RN
Council Bluffs, IA
State Health Solutions /
Full-Time /
Hybrid
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.
Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.
Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and helth shape the future of health.
Are you Ready?
We’re on a mission to transform lives and economies by improving health.
Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
Thank you for your interest in Telligen!
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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.
Telligen and our affiliates are Equal Opportunity Employers 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. We will not accept 3rd party solicitations from outside staffing firms.
