Senior RN Review Coordinator, PT - Saturday and Sunday

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🔥 1 hour ago

🇺🇸 United States – Remote

⏱ Part Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Telligen

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Telligen is a trusted partner for U. S. government health agencies, state Medicaid agencies, self-funded employer and Taft-Hartley health plans, and managed care organizations. The company aims to improve health outcomes for millions of people nationwide through proven health management solutions and healthcare expertise. Telligen provides quality improvement, data analytics, quality measures, program management, and health information technology solutions to federal and state health agencies and national programs. It also offers utilization management, care management, and wellness solutions for health plans and employers. Their work includes efforts as a Quality Innovation Network-Quality Improvement Organization and a Hospital Quality Improvement Contractor across multiple states. Telligen has received Population Health Program Accreditation for its expertise in population health management.

📋 Description

• Conduct prospective, concurrent, or retrospective utilization review/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 failing screening criteria to a peer reviewer • Coordinate and participate in peer-to-peer reviews • Deviate from criteria with management approval and proper justification to authorize services • Serve as liaison between peer reviewers, providers, facilities, and/or subscribers • Coordinate and participate in appeals as directed by management • Train or mentor team members and physician reviewers • Perform preliminary research on experimental or cosmetic services, coverage determinations, coding, and standards of care • Document review and special project results accurately and timely in the workflow documentation system • Assist with compliance reporting • Perform miscellaneous duties as assigned • Provide technical assistance, medical record review, and support to provider staff and physician reviewers

🎯 Requirements

• Four-year degree or two- or three-year degree in nursing • 3+ years recent experience working in a clinical environment • Current California RN license or ability to obtain within 3 months of hire (company paid) • Current RN license must be unrestricted, or any permitted restriction must not affect the ability to fulfill reviewer responsibilities • Ability to maintain regular and predictable attendance • Must be located in the United States, excluding California and U.S. Minor Outlying Islands and territories • Preferred: prior utilization management experience • Preferred: strong oral/written communication, professional image, attention to detail, teamwork, technical expertise, good judgment, and relationship-building/influencing skills

🏖️ Benefits

• Employee ownership through a 100% employee-owned company • General benefits and other compensation described in Telligen's Benefits Summary • Company-paid California RN license acquisition if obtained within 3 months of hire • Equal Opportunity Employer • Reasonable accommodations during the employment process

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