Senior Review Coordinator - Masters in Social Work

Telligen • Columbia, MD

22h • $74,000 - $90,000 • Onsite

About The Position

As a Senior Review Coordinator , you will be responsible for performing utilization review of plans of service for home and community-based programs. This reviewer will review the complex plans of service and act as a resource for non-clinical reviewers. This position directly impacts the MD population and their access to much-needed services. This position makes a difference in people’s lives by ensuring they receive adequate support to remain at home instead of an institution. Training for this role will take place on-site at our Columbia, MD office. Training is expected to run for approximately 4 weeks during standard business hours. Training duration is dependent upon the individual and may run longer or shorter depending on needs. Essential Functions Perform utilization review of plans of service for home and community-based programs. You will review the complex plans of service and act as a resource for non-clinical reviewers. You will act as a resource for non-clinical reviewers. You will provide independent review decisions for behavioral health services and the appropriateness of quality of care based on contract, state or URAC requirements. You will screen situations according to specific criteria to determine if care is appropriate. Refer cases that fail to meet criteria to peer reviewers. Ensure review is conducted thoroughly and within specified timeframes. Serve as liaison among peer reviewers, providers, facilities, and/or subscribers. Document medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely.

Requirements

• Licensed Masters in Social Work, LMSW or LCSW, or LCSW-C
• 3 – 5 years of recent experience working in a clinical environment
• Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems
• Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential
• Good written and oral communication skills are required
• Up to 5% local and overnight travel - valid driver's license required
• We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories

Nice To Haves

• Prior UM experience is preferred
• Familiarity with Home and Community Based Services (HCBS) waiver programs is a plus
• Durable Medical Equipment experience is a plus

Responsibilities

• Perform utilization review of plans of service for home and community-based programs.
• Review the complex plans of service and act as a resource for non-clinical reviewers.
• Act as a resource for non-clinical reviewers.
• Provide independent review decisions for behavioral health services and the appropriateness of quality of care based on contract, state or URAC requirements.
• Screen situations according to specific criteria to determine if care is appropriate.
• Refer cases that fail to meet criteria to peer reviewers.
• Ensure review is conducted thoroughly and within specified timeframes.
• Serve as liaison among peer reviewers, providers, facilities, and/or subscribers.
• Document medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees