Senior Review Coordinator (RN)

Telligen • Maryland, MD

23h

About The Position

As a Senior Review Coordinator, you will be responsible for conducting utilization review/medical management including prospective, concurrent and retrospective review for all services. You will be responsible for training/mentoring other team members and performing preliminary research on requested topics. In addition, you may provide technical assistance, medical record review and support to provider staff and physician reviewers.

Requirements

• Active RN license that is recognized in the state of Maryland
• Four-year degree in health care or two- or three-year degree in nursing or related field and/or equivalent training and/or experience
• Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems
• The ability to maintain regular and predictable attendance is essential

Nice To Haves

• Prior Utilization Management (UM) experience
• Durable Medical Equipment experience
• Knowledge of medical coding and billing
• Proficiency in Microsoft Office products
• Proficient math skills

Responsibilities

• Perform utilization review of Durable Medical Equipment (DME), Audiology, and Air Ambulance services including appropriateness of quality of care based on contract, state, or URAC requirements
• Screen individual situations according to specific criteria to determine if care is appropriate; with prior management approval, may deviate from criteria with proper justification to authorize the service
• Refer cases that fail to meet screening criteria to peer reviewer
• Coordinate and participate in peer-to-peer review as warranted
• Serve as liaison between peer reviewer, provider, facility and/or subscriber
• Coordinate and participate in appeal process as directed by management
• 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.
• Perform preliminary research on topics such as experimental or cosmetic services, coverage determinations, coding or standards of care.
• Document review and special project results in workflow documentation system, ensuring data is accurate and timely.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree