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.
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.
