Senior RN Review Coordinator, PT - Saturday and Sunday

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform prospective, concurrent, or retrospective utilization review and medical management for all services.

• Evaluate the appropriateness of care in accordance with contract, state, or URAC standards.

• Assess individual cases using specific criteria to determine the suitability of care.

• Forward cases that do not meet screening criteria to a peer reviewer.

• Coordinate and engage in peer-to-peer reviews.

• Make exceptions to criteria with management's approval and valid justification to authorize services.

• Act as a liaison among peer reviewers, providers, facilities, and/or subscribers.

• Organize and take part in appeals as instructed by management.

• Train or mentor team members and physician reviewers.

• Conduct preliminary research on experimental or cosmetic services, coverage determinations, coding, and standards of care.

• Accurately and promptly document review and special project outcomes in the workflow documentation system.

• Assist with compliance reporting.

• Carry out miscellaneous tasks as assigned.

• Provide technical assistance, medical record review, and support to provider staff and physician reviewers.

⛳️ Requirements

• Bachelor’s degree or a two- or three-year degree in nursing.

• At least 3 years of recent experience in a clinical setting.

• Current California RN license or the ability to secure one within 3 months of hiring (company funded).

• The current RN license must be unrestricted, or any allowed restrictions must not impede reviewer responsibilities.

• Capability to maintain consistent and reliable attendance.

• Must reside in the United States, excluding California and U.S. Minor Outlying Islands and territories.

• Preferred: previous experience in utilization management.

• Preferred: strong oral and written communication skills, professional demeanor, attention to detail, teamwork, technical proficiency, sound judgment, and relationship-building/influencing abilities.

🏝️ Benefits

• Employee ownership through a 100% employee-owned organization.

• Comprehensive benefits and additional compensation detailed in Telligen's Benefits Summary.

• Company-funded acquisition of California RN license if obtained within 3 months of hiring.

• Equal Opportunity Employer.

• Reasonable accommodations provided during the employment process.