New

Sr Review Coordinator RN

Telligen
United States, Maryland, Columbia
9891 Broken Land Parkway (Show on map)
Oct 06, 2025
This position will be responsible for performing utilization review/medical management including prospective, concurrent and retrospective review for all services. Essential Functions Perform utilization review of plans of service for home and community-based programs. You will review the complex plans of service and act as a resource for non-clinical reviewers. You will act as a resource for non-clinical reviewers. You will provide independent review decisions for behavioral health services and the appropriateness of quality of care based on contract, state or URAC requirements. You will screen situations according to specific criteria to determine if care is appropriate. Refer cases that fail to meet criteria to peer reviewers. Ensure review is conducted thoroughly and within specified timeframes. Serve as liaison among peer reviewers, providers, facilities, and/or subscribers. Document medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely. Requirements Compact RN License 3 - 5 years of recent experience working in a clinical environment Prior UM experience is preferred Knowledge of medical coding and billing is preferred Durable Medical Equipment experience is a plus Discharge planning experience is a plus Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential Good written and oral communication skills are required Up to 5% local and overnight travel - valid driver's license required We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories 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. Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions. Our business is our people and we're seeking talented individuals who share our passion and are ready to take ownership, make an impact and helth shape the future of health. Are you Ready? We're on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success. Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are. Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives. Integrity: We foster a respectful, inclusive, and collaborative environment built on trust 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. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. 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.