Telligen
Population Health Management
Sr.ReviewCoordinatorRN
“Sr. Review Coordinator RN at Telligen. Skills: Utilization review, Medical management, Nursing, EHR. Conduct utilization review/medical management. Train/mentor team members”
What You'll Achieve.
Ensure reviews and appeals are conducted thoroughly and within specified time frames; Ensure data is accurate and timely
Industry & Context.
Perform preliminary research on requested topics
U. S. Citizenship may be required for specific contracts
What They're Looking For.
Must Have
Two- or three-year degree in nursing, 3 – 5 years recent experience working in a clinical or behavioral health environment, Valid California Nursing License or the ability to obtain this licensure, Ability to maintain regular and predictable attendance
Nice to Have
Knowledge of URAC standards, Understanding of mental health diagnoses, Understanding of substance abuse treatment, Understanding of utilization management criteria (e.g., InterQual, MCG), Proficiency with Electronic Health Records (EHR), Proficiency with utilization management software
What You'll Do.
Conduct utilization review/medical management
Train/mentor team members
Perform preliminary research
Provide technical assistance
Perform medical record review
Support provider staff
Support physician reviewers
retrospective utilization review
Screen situations by criteria
Refer cases failing criteria
Coordinate peer-to-peer review
Participate in peer-to-peer review
Deviate from criteria with justification
Coordinate appeal process
Participate in appeal process
Train/mentor team members and physician reviewers
Document review and project results
Assist in compliance reporting
Perform miscellaneous duties
How You'll Work.
Team & Collaboration
Serve as liaison between peer reviewer, provider, facility and/or subscriber; Train or serve as a mentor to team members and physician reviewers
Communication Scope
Serve as liaison
Process & Methodology
Document special project results
Applying for this Sr. Review Coordinator RN role?
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