Job Description
As a
Senior Review Coordinator , you will be responsible for conducting utilization management/level of care for initial, concurrent and retrospective reviews for nursing facilities, skilled nursing facilities, and Program of All Inclusive Care for the Elderly (PACE). You will work as part of a team to provide high-quality services that directly impact our customers.
Schedule: 8:00 AM - 4:30 PM CST, Monday thru Friday.
Essential Functions - Conduct Minimum Data Set (MDS) validation reviews on Medicaid nursing facility residents for coding accuracy and identify inconsistencies in quality measures.
- Assist with MDS data pull for validation reviews and Case Mix Index (CMI) for Medicaid reimbursement.
- Perform prospective, continued stay, and retrospective utilization/medical management reviews
- Refer cases to a physician reviewer if unable to approver per established criteria
- Complete reviews within the specified timeframe, consistently meet deadlines, and ensure data is accurate and timely within data management systems.
- Utilize typing and data entry skills and demonstrate familiarity with computer systems and multiple monitor work systems.
- Coordinate and participate in the appeal process, including representing the customer in appeal hearings.
- Collaborate with peers and work effectively with team members on the waiver review team and the larger Quality Improvement Organization (QIO) team.
- Look for and participate in process improvement opportunities/projects.
- Participate in quality review activities.
Requirements - Valid Iowa LPN/RN License
- Four-year degree in health care or two or three-year degree in nursing or related field and/or equivalent training and/or experience
- 3 - 5 years of recent experience working in a clinical environment
- Located in Des Moines or surrounding areas with an ability to be co-located with our customers if required
- Good written and oral communication skills are required
- Must have an ability to work independently as well as with a team and be self-directed in a fast-paced environment
- Experience with nursing facility long-term and skilled care
- Have the ability to travel 5% local and/or overnight travel
- Current Resident Assessment Coordinator-Certified (RAC-CT) preferred
- Minimum Data Set (MDS) 3.0 with experience in MDS coordinator role, Patient Driven Payment Model (PDPM), completion of the MDS process and Case Mix Index (CMI) for Medicaid reimbursement experience preferred
- This role may require valid driver's license and Motor Vehicle Record check
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
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. Telligen
Job Tags
Local area, Remote job, Night shift, Monday to Friday,