Senior Review Coordinator RN PACE
Iowa
State Health Solutions /
Full-Time /
Hybrid
As a Senior Review Coordinator, you will perform utilization management/level of care for initial, concurrent and retrospective reviews for nursing facilities, skilled nursing facilities and Program of All Inclusive Care for the Elderly (PACE).
You will complete level of care review and documentation of medical information into appropriate systems accurately and within the established time frames and approve level of care appropriately for short-term and long-term placement in the nursing facility.
You will refer cases to physician review when criteria are not met. You will assist the Iowa Medicaid PACE program manager with conducting quality oversight for the PACE programs. This includes assisting with onboarding new PACE organizations/PACE expansion and annual desk and/or onsite audit reviews for all PACE sites.
Core business hours are 8:00 AM – 4:30 PM CST, Monday thru Friday
Essential Functions
- Conduct medical necessity and level of care reviews utilizing approved medical criteria for initial and concurrent reviews.
- Refer cases to physician reviews when criteria is not met.
- Foster effective communication and collaboration with co-workers, policy staff, providers, and other involved in care management.
- Comply with policies and procedures, accreditation standards and Iowa Medicaid Quality Improvement Organization contractual requirements.
- Assist the Iowa Medicaid PACE Quality Oversight team in conducting the PACE program audit and quality reviews.
Requirements
- Licensed Registered Nurse in Iowa.
- 3 – 5 years recent experience working in a clinical environment
- Valid Iowa driver’s license.
- Willing to travel 3-4 times per year to PACE facilities to conduct onsite audit reviews. PACE reviews are completed for PACE facilities located in Des Moines, Waterloo, Cedar Rapids, Bettendorf, Cedar Rapids, Council Bluffs and Sioux City.
- UM experience, quality oversight, level of care reviews, nursing facility and/or PACE experience.
- Experience with Microsoft Suite products.
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!
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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.
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 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.
