Senior Review Coordinator
3 months ago
The Review Coordinator will be responsible for performing utilization review/medical management including prospective, concurrent, and retrospective reviews for all services.
Essential Functions:
- Provides independent review decision for prospective, concurrent or retrospective utilization review/medical management cases. Cases can consist of inpatient, outpatient, procedure, DME, and therapy services as well as appropriateness of quality of care based on contract, state or URAC requirements. Cases failing to meet criteria are referred to a peer reviewer. This individual will screen situations according to specific criteria to determine if care is appropriate.
- Refers cases that fail to meet criteria to peer reviewer. Ensures review is conducted thoroughly and within specified timeframes. Serves as liaison among peer reviewer, provider, facility and/or subscriber.
- Documents medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely.
- Performs miscellaneous duties as assigned.
- Valid RN license in Mississippi
- 3-5 years experience in nursing in a clinical environment.
- Functional knowledge of PC is required.
- Must be able to work in the Ridgeland, MS office daily.
- Knowledge of medical coding and billing is preferred.
- Experience working in an insurance or managed care environment is preferred.
COMMITMENT TO SAFETY
As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination)
Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.
Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions.
Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us
Are you Ready?
We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.
Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.
Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.
Ingenuity: We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away
Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.
Thank you for your interest in Telligen
Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), 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.
Telligen does not accept 3rd party solicitations from outside staffing firms.
-
Senior Review Coordinator
2 months ago
Ridgeland, United States Telligen Full timeThe Review Coordinator will be responsible for performing utilization review/medical management including prospective, concurrent, and retrospective reviews for all services.Essential Functions: Provides independent review decision for prospective, concurrent or retrospective utilization review/medical management cases. Cases can consist of inpatient,...
-
Resident Activities Coordinator
4 weeks ago
Ridgeland, Mississippi, United States Discovery Senior Living Full timeJoin a dynamic team at Discovery Senior Living, where we prioritize delivering exceptional care and quality of life for our residents. As a Senior Living Experience Director, you will play a key role in creating engaging lifestyle programs that promote physical, emotional, and social well-being.The estimated salary for this position is $65,000 - $85,000 per...
-
Senior Living Experience Director
1 month ago
Ridgeland, Mississippi, United States Discovery Senior Living Full timeAre you passionate about creating engaging experiences for seniors? Do you have a background in recreation, education, or a related field? We're seeking a highly motivated Resident Activities Coordinator to join our team at Discovery Senior Living.The estimated salary for this position is $55,000 - $75,000 per year, depending on location and experience.About...
-
Assisted Living Support Professional
2 hours ago
Ridgeland, Mississippi, United States VITALITY Senior Living Full timeJoin Our Team at Vitality Senior LivingWe are seeking a compassionate and dedicated caregiver specialist to join our team. As a caregiver specialist at Vitality Senior Living, you will have the opportunity to make a real difference in the lives of seniors and their families. This is a full-time position with a competitive salary of $45,000 - $55,000 per...
-
Personal Care Team Member
3 hours ago
Ridgeland, Mississippi, United States VITALITY Senior Living Full timeCareer Opportunities at Vitality Senior LivingWe are seeking a dedicated and compassionate caregiver specialist to join our team. As a caregiver specialist at Vitality Senior Living, you will have the opportunity to make a real difference in the lives of seniors and their families. This is a full-time position with a competitive salary of $45,000 - $55,000...
-
Tax Senior Associate
4 days ago
Ridgeland, United States HORNE LLP Full timeThis is a Tax Senior Associate position located in Ridgeland, Ms. Job Summary: Managers are responsible for managing multiple projects simultaneously, and assisting with scheduling, staffing, and coordinating workflow. Managers develop and train staff. Advanced technical skills with well-developed and applied management and supervisory skills are required....
-
Senior Tax Manager
7 days ago
Ridgeland, United States HORNE LLP Full timeHORNE is a professional services firm founded on a cornerstone of public accounting. As a top 25 business advisory firm, our 2,000+ team members serve clients from offices and project locations across the nation and Puerto Rico. Our Public and Middle Market team brings an owner's mindset to companies and delivers game-changing results. We help clients...
-
Rehab Coordinator
6 months ago
Ridgeland, United States TMC Full timeOverview: Ask about our tuition assistance program! Is your current employer willing to help you go to school to become a clinician? As TMC's Rehab Coordinator, you will oversee administrative tasks and coordinate patient care while assisting in the efficient daily operation of the therapy department under the supervision of the Therapy Care Navigator. You...
-
Utilization Management Coordinator
2 weeks ago
Ridgeland, Mississippi, United States Telligen Full timeAbout the RoleWe are looking for a highly motivated Utilization Management Coordinator to join our team. In this role, you will be responsible for conducting reviews of medical services to ensure they meet established criteria for medical necessity and quality of care. You will also collaborate with healthcare professionals to resolve issues and improve...
-
Manager, Comprehensive Tax Solutions
7 days ago
Ridgeland, United States HORNE LLP Full timeThis is a position for a (Manager, Comprehensive Tax Solutions) located in Ridgeland. Summary: Tax managers are responsible for the review and management of their assigned client work. They are also responsible for managing multiple projects simultaneously and coordinating workflow amongst the team. Managers will assist associates, and senior associates...
-
Personal Injury Trial Coordinator
2 weeks ago
Ridgeland, Mississippi, United States Derek L. Hall, PC Full timeResponsibilities and QualificationsManage and maintain organized files and documents efficientlyCoordinate events and assignments effectivelyCollaborate closely with court administrators and personnelAssist clients in completing and submitting legal forms accuratelyPrepare drafts of letters and simple court documents for attorney reviewTo be considered for...
-
Tax Senior Manager/Partner
3 days ago
Ridgeland, United States BMSS, LLC Full timeJob Description & Summary BMSS, LLC is looking for a client-focused leader who values cultivating relationships internally and externally to join our Tax team as either a Senior Manager or potential Member. BMSS was established in Birmingham in 1991 and has grown to become a top 100 advisory and CPA firm in the U.S. We have four locations in Alabama (Hoover,...
-
Tax Senior Manager/Partner
5 days ago
Ridgeland, United States BMSS, LLC Full timeJob DescriptionJob DescriptionJob Description & SummaryBMSS, LLC is looking for a client-focused leader who values cultivating relationships internally and externally to join our Tax team as either a Senior Manager or potential Member. BMSS was established in Birmingham in 1991 and has grown to become a top 100 advisory and CPA firm in the U.S. We have four...
-
Paralegal Coordinator
2 weeks ago
Ridgeland, Mississippi, United States Derek L. Hall, PC Full timeAbout Derek L. Hall, PC:Derek L. Hall, PC is a reputable law firm based in Ridgeland, Mississippi, dedicated to delivering exceptional results for our clients. We prioritize employee growth and development, fostering a collaborative environment that encourages innovation and excellence.Why Join Our Team:As a Senior Legal Assistant at Derek L. Hall, PC, you...
-
Senior Geologist
5 days ago
Ridgeland, United States WSP Full timeOur Business We are a global leader in environmental consulting - made stronger with the recent acquisition of Wood’s Environment & Infrastructure business and Golder - with world-class expertise in environmental, social and governance (ESG), climate resiliency & sustainability (CRS), and earth sciences. Combined we have over 20,000 multidisciplinary...
-
Senior Engagement Director
1 hour ago
Ridgeland, Mississippi, United States Ridgeland Place Assisted Living and Memory Care Full timeJob ResponsibilitiesDevelop and implement engaging activities and events that promote socialization, cognitive stimulation, and emotional well-being among residents.Collaborate with the care team to ensure seamless integration of activities into daily routines.Plan and execute large-scale events, such as themed parties and holiday celebrations.Assist with...
-
Senior Estimator
2 months ago
Ridgeland, United States Century Construction Group, Inc. Full timeIn twenty-five short years, Century Construction has evolved into one of the most respected contracting firms in our region. Driven by customer needs and our own demanding expectations, Century Construction has cultivated a reputation for delivering remarkable results for a diverse group of market sectors and clients.Our experienced team of industry...
-
Senior Estimator
8 months ago
Ridgeland, United States Century Construction Group, Inc. Full timeIn twenty-five short years, Century Construction has evolved into one of the most respected contracting firms in our region. Driven by customer needs and our own demanding expectations, Century Construction has cultivated a reputation for delivering remarkable results for a diverse group of market sectors and clients.Our experienced team of industry...
-
Paralegal Legal Assistant
3 days ago
Ridgeland, United States Derek L. Hall, PLLC Full timeExciting opportunity for a Paralegal/legal assistant to join our growing team at the Ridgeland, MS office. This is a full-time position with an attractive salary and comprehensive benefits package. We are in search of a dedicated Paralegal to provide support to our personal injury trial attorneys at our bustling injury law and family law firm in Ridgeland,...
-
Fixed Asset Specialist
4 days ago
Ridgeland, United States Madison County Board of Education Full timePosition Type: Secretarial/Clerical Date Posted: 11/13/2024 Location: Madison County Central Office Date Available: 04/01/2025 Closing Date: 01/03/2025 Applicants Must Apply Online Job Title: Fixed Asset Specialist Work Days: 225 (12-months) Reports To: Finance Director FLSA Status: Non-Exempt JOB SUMMARY This position provides general support to the...