Sr. Review Coordinator - RN

The main responsibilities of the Senior Review Coordinator - RN at Telligen include conducting utilization reviews and medical management of health services, mentoring team members, performing technical assistance, and spearheading research related to eligibility and quality of care. This role ensures that health services are reviewed for appropriateness, coordinating peer reviews, and assisting in the appeal process when needed.

To qualify for the Senior Review Coordinator - RN position at Telligen, candidates must have a current RN license recognized in relevant jurisdictions, ideally unrestricted. Additionally, a four-year degree in healthcare or an equivalent degree is necessary. Having 3 to 5 years of recent clinical experience, preferably in acute care or ICU environments, is highly recommended to succeed in this role.

The Senior Review Coordinator - RN contributes to team training at Telligen by mentoring and educating fellow team members and physician reviewers. This involves ensuring that they conduct thorough reviews and appeals on time. The role emphasizes collaboration and knowledge-sharing, fostering a supportive environment that enhances the capabilities of the entire team.

As a Senior Review Coordinator - RN at Telligen, you can expect a friendly, supportive, and professional environment that values integrity and teamwork. The company sees its employee-owners as a pivotal part of the business, promoting a culture that encourages open communication, innovation, and compliance to uphold the highest standards in healthcare.

Career growth opportunities for a Senior Review Coordinator - RN at Telligen include potential advancement to managerial positions or specialized roles within medical management and utilization review. Since Telligen values employee development, there are pathways for increased responsibilities, continued education, and contributions to innovative healthcare solutions.

Certainly! When answering this question, focus on specific examples from your past roles where you conducted utilization reviews, the criteria you used to assess appropriateness of care, and how your decisions positively impacted patient outcomes or operational efficiency. Be sure to mention any collaborative efforts with peers or stakeholders to illustrate your teamwork skills.

When faced with disagreements, it’s essential to remain professional and focused on objective criteria. Start by discussing your rationale for the review and seeking to understand the peer reviewer’s perspective. Highlight your conflict resolution skills by noting any strategies you've used to reach a consensus or escalate the issue constructively.

In your response, share specific strategies like providing hands-on training sessions, shadowing opportunities, or regular feedback loops. Emphasize your approach to encouraging questions, creating a supportive environment, and sharing knowledge to empower mentees, highlighting the positive impact of your mentorship in past experiences.

To stay current with URAC and NCQA requirements, I actively participate in relevant training, attend industry conferences, and subscribe to health policy newsletters. Highlight any certifications you may hold, and mention how you integrate this knowledge into your daily responsibilities to ensure compliance and optimal care quality.

When discussing a challenging review case, provide a specific example that showcases your analytical and decision-making skills. Outline the complexities involved, how you approached the situation, the steps you took to address it, and the outcome. This demonstrates your problem-solving abilities and dedication to quality care.

Mention specific documentation tools or workflow systems you have experience with, emphasizing your efficiency in maintaining accurate records. Describe how you ensure timely and precise documentation for reviews, as well as how that impacts the overall review process at Telligen.

In such a scenario, it’s important to communicate openly with the physician about the relevant criteria and the justification for your recommendation. Focus on collaboration and aiming to find a solution that honors clinical judgment while adhering to review standards. This displays your ability to balance patient care with compliance.

Key attributes include strong analytical skills, effective communication, and the ability to work collaboratively. Additionally, being detail-oriented and possessing a deep understanding of healthcare standards ensure the quality and appropriateness of care. Describe how you embody these qualities and how they’ve contributed to your success in previous roles.

Provide a concrete example where you identified an area for improvement in the review process, the initiative you took to address it, and the positive results that stemmed from your efforts. This showcases your problem-solving skills and commitment to continuous improvement in clinical processes.

In answering this question, express your enthusiasm for Telligen's mission of improving health outcomes and your alignment with its core values. Mention your eagerness to contribute your expertise to a team that values innovation and community and how you see yourself growing within the organization.