Senior Review Coordinator - RN

Senior Review Coordinator - RN 

This role must be located in Maryland with possibility to work remotely. Training will take place in our Columbia office.

As a Senior Review Coordinator, you will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on requested topics. In addition, you may provide technical assistance, medical record review, and support to provider staff and physician reviewers.  

This position will have a 6 week training in our office upon hire.

• Perform Provisional, Initial, Annual and Revised Reviews to include quality of care that includes a detailed picture of all services the individual is currently receiving or has requested based on contractual and state standards utilizing the LTSS State System.
• Refer cases that fail to meet screening criteria to peer reviewers. based on contractual and state standards. 
• Perform onsite as well as electronic health record reviews to determine the appropriateness of care. 
• Refer cases that fail to meet screening criteria to peer reviewers.
• Coordinate and participate in peer-to-peer reviews as warranted.
• Serve as a liaison between the peer reviewer, provider, facility, and/or subscriber.
• Coordinate and participate in the appeal process as appropriate.
• Document review activity in data management systems, ensuring data is accurate and timely.
• Assist in compliance reporting tasks and quality assurance reviews. 

• Compact RN License.
• 3 – 5 years of recent experience working in a clinical environment
• Prior UM experience with Home and Community Based Waiver experience .
• Prior interRAI assessment experience.
• Prior Case Management experience.
• 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.