Senior Review Coordinator (RN)

Job Overview 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. Responsibilities Perform utilization review of Durable Medical Equipment (DME), Audiology, and Air Ambulance services including appropriateness and 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. Required Skills and Experience Active RN license 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. Ability to maintain regular and predictable attendance. Possibility of occasional weekend work. Only candidates within the United States, excluding California and US Minor Outlying Islands and territories. Preferred Skills and Experience Prior Utilization Management (UM) experience. Durable Medical Equipment experience. Knowledge of medical coding and billing. Proficiency in Microsoft Office products. Proficient math skills. Equal Opportunity Employment Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms. Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class. Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case‑by‑base basis. If you need assistance to navigate Telligen's careers website or to apply for a position, please send an email to View email address on click.appcast.io. #J-18808-Ljbffr Telligen