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Senior Review Coordinator

1 month ago

Ridgeland, Mississippi, United States Telligen Full time
Job Summary

The Senior Review Coordinator will be responsible for performing utilization review/medical management including prospective, concurrent, and retrospective reviews for all services. This role requires a strong understanding of medical management principles and the ability to make independent review decisions.

Key Responsibilities
  • Provides independent review decision for prospective, concurrent or retrospective utilization review/medical management cases.
  • Reviews cases for appropriateness of care based on contract, state or URAC requirements.
  • 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.

Requirements
  • 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).

About Us
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. 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

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. 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. 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. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence. Thank you for your interest in Telligen. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time.