Review Coordinator Lead - Utilization Management

Job Description

Job Description

As a Review Coordinator Lead - Utilization Management , You will be responsible for conducting complex utilization review / medical management and mentoring team members. You will partner with team members to develop and implement quality improvement and special project initiatives. You will be responsible for assisting in the promotion of the initiatives to external customers.

This is a hybrid role requiring you to work one day per week in the office, with the remaining days remote.

Essential Functions

• You will perform prospective, concurrent or retrospective utilization review / medical management for all services and quality of care based on contract, state or URAC requirements.
• You will refer cases that fail to meet criteria to a peer reviewer.
• You will collaborate with team members and other health care professionals to develop, implement and complete quality improvement and special project or corrective action initiatives based on review results.
• You may need to perform technical writing and coordinate the development of materials to promote and support initiatives, or perform extensive research on requested topics to develop projects.
• You will serve as liaison with internal and external customers to ensure projects, plans and / or products are completed satisfactorily.
• You will maintain positive relationships with internal and external clients to ensure continued participation.
• You will serve as a representative of the Company at external client meetings.
• You will train and serve as a mentor to team members to ensure reviews and appeals are conducted thoroughly and within specified time frames.
• You will document review and special project results in workflow documentation system, ensuring data is accurate and timely.
• You will assist in compliance reporting.

Requirements

Preferred Skills and Certifications

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!

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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.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.