RN Senior Review Coordinator PT - Saturday's and Sunday's

Telligen

35d • Remote

About The Position

The Senior Review Coordinator RN conducts utilization review and medical management for all services, including prospective, concurrent, and retrospective reviews. The role includes training and mentoring team members and physician reviewers, preliminary research on requested topics, and may include technical assistance, medical record review, and support for provider staff and physician reviewers. This is a home-based, part-time role working Saturdays and Sundays for under 20 hours.

Requirements

• Four-year degree or two- or three-year degree in nursing.
• At least 3 years of recent experience working in a clinical environment.
• Current California RN license or ability to obtain one within 3 months of hire; the company pays for the license.
• Current RN license must be unrestricted, except for a restriction permitted by the relevant jurisdiction that, in the Medical Director's judgment, does not affect the ability to fulfill reviewer responsibilities.
• Ability to maintain regular and predictable attendance.
• Candidates must be located in the United States and not in California, the U.S. Minor Outlying Islands, or U.S. territories.

Nice To Haves

• California RN license.
• Prior utilization management experience.
• Strong oral and written communication.
• Professional image.
• Attention to detail.
• Teamwork skills.
• Technical expertise.
• Good judgment.
• Relationship-building and influencing skills.

Responsibilities

• Conduct prospective, concurrent, or retrospective utilization review and medical management for all services.
• Review appropriateness of care based on contract, state, or URAC requirements.
• Screen individual situations using specific criteria to determine whether care is appropriate.
• Refer cases that fail to meet screening criteria to a peer reviewer.
• Coordinate and participate in peer-to-peer reviews as warranted.
• With prior management approval, deviate from criteria with proper justification to authorize a service.
• Serve as liaison among peer reviewers, providers, facilities, and subscribers.
• Coordinate and participate in the appeal process as directed by management.
• Train or mentor team members and physician reviewers to help ensure reviews and appeals are thorough and completed 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 the workflow documentation system, ensuring data is accurate and timely.
• Assist in compliance reporting.
• Perform miscellaneous duties as assigned.

Benefits

• The company states that a general description of benefits and other compensation for the position is available in its Benefits Summary.
• Telligen is a 100% employee-owned company.

What This Job Offers

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