Telligen

Manager

• Manage the day-to-day operations of Utilization Management programs across multiple contracts and populations.
• Lead planning, implementation, evaluation, and ongoing management of UM workflows to ensure compliance with regulatory, accreditation, and contractual requirements.
• Monitor key UM performance indicators including timeliness, determination accuracy, appeal overturn rates, and documentation quality. When risks or gaps are identified, leads root cause analysis and corrective action planning.
• Ensure UM operations remain compliant with applicable federal and state regulations, client requirements, and accreditation standards (e.g., URAC).
• Partner with Quality and Compliance teams to support audits, corrective action plans (CAPs), policies, procedures, and readiness activities.
• Lead continuous improvement initiatives focused on clinical consistency, medical necessity application, letter accuracy, peer review processes, and regulatory adherence.
• Maintain financial accountability for assigned UM contracts, including staffing models, productivity expectations, and budget adherence.
• Monitor operational performance against contractual service level agreements (SLAs) and utilization benchmarks.
• Participate in proposal development, pricing inputs, and operational feasibility discussions as a UM subject matter expert.
• Coach, guide, and direct UM staff to achieve individual, team, and organizational objectives.
• Ensure appropriate training, competency validation, and ongoing education for UM nurses, physician reviewers, and support staff.
• Foster a culture of accountability, clinical integrity, and continuous improvement consistent with Telligen’s Management Philosophy that managers coach, engage, and support people to achieve results.
• Represent Telligen in meetings with clients, providers, regulators, and internal stakeholders related to UM operations.
• Collaborate with Medical Directors, Compliance, Quality, and Operations leadership to resolve issues and improve service delivery.
• Stay current on utilization management trends, regulatory updates, accreditation changes, and evolving medical management best practices.

Quality Improvement Manager – Utilization Management

Communications

• Provide strategic leadership for internal and external communications
• Implement client program efforts and execute integrated marketing and communication initiatives
• Achieve program deliverables and objectives by understanding the requirements
• Tailor work to meet needs while protecting the company’s brands
• Demonstrate strong strategic communication and problem-solving skills with clients, peers, management, and program staff
• Develop and implement comprehensive marketing and communication strategies
• Lead all internal and external communications functions to ensure consistent messaging
• Establish and maintain relationships with senior stakeholders
• Oversee multiple concurrent projects and initiatives

Lead Marketing and Communications Consultant

• Provide strategic leadership for internal and external communications implementing client program efforts and executing integrated marketing and communication initiatives.
• Achieve the intent of the program deliverables and objectives by understanding the requirements and tailoring work to meet those needs while protecting the company’s brands.
• Demonstrate strong strategic communication and problem-solving skills with clients, peers, management, and program staff.
• Lead and mentor marketing/communications team members.
• Develop and implement comprehensive marketing and communication strategies for select client programs.
• Establish and maintain relationships with senior stakeholders, both internal and external.
• Collaborate with workgroups and key staff members to define marketing and communication needs in order to develop integrated solutions.
• Provide strategic counsel to program leadership on communication approaches.
• Manage deliverable schedules for projects that include graphics, website design and functionality, white papers, newsletters, presentations, collateral and other communication activities, outreach, and analysis.
• Lead all internal and external communications functions to ensure consistent, cohesive, and effective messaging that fulfills the communications and branding requirements of the program.
• Create presentations for various meetings, conferences and events.
• Create and lead development of promotional materials such as brochures, newsletters, collateral materials and white papers.
• Lead development of regular communications to clients, prospects, stakeholders and other audiences including newsletters, and other electronic forms of communication.
• Establish program-wide processes and standards for communications.
• Oversee multiple concurrent projects and initiatives.
• Implement quality control processes across all communication channels.
• Develop and track program-level metrics and KPIs.
• Resolve complex issues and remove barriers to success.
• Ensure communication materials comply with company, customer and regulatory standards by implementing editorial standards for communication content.

Client Services Representative

• This position is responsible for receiving and responding to inbound customer inquiries
• Performing outreach to providers and members
• Providing program support for contract members
• Providing technical and administrative support for various contracts, including support of internal applications and tools

Part-Time Client Service Specialist

• Responsible for receiving and responding to inbound customer inquiries
• Perform outreach and follow up to gather data or provide information
• Perform data entry and maintains data integrity
• Ensure the highest level of customer satisfaction by responding to calls from internal and external clients
• Provide customer support including answering general inquiries, troubleshooting issues, and gathering information
• Work as an engaged team member to provide feedback and suggest improvements

Client Service Specialist

• Focus on the care management of patients with acute and chronic medical conditions
• Assess care needs of vulnerable populations for various clients
• Collaborate with health care providers to assure coordination of care
• Provide ongoing education and support to patients to improve health management skills
• Document per contractual requirements related to individual member status

Registered Nurse – Care Manager

Community Manager

• Conduct comprehensive quality evaluations of HCBS waiver, Habilitation, CNRS providers, and self-directed services
• Assess provider compliance with state and federal regulations, policies, and procedures
• Develop and implement corrective action plans with providers
• Provide technical assistance and guidance to providers on HCBS topics.
• Document findings and maintain detailed records of provider evaluations
• Analyze data and prepare reports on provider performance and compliance
• Facilitate training sessions and educational workshops for providers
• Collaborate with stakeholders to implement quality improvement initiatives
• Monitor provider progress in meeting quality standards
• Stay current with evolving HCBS regulations and best practices

Home and Community Based Services Specialist

• Conduct comprehensive quality evaluations of HCBS waiver, Habilitation, CNRS providers, and self-directed services
• Assess provider compliance with state and federal regulations, policies, and procedures
• Develop and implement corrective action plans with providers
• Provide technical assistance and guidance to providers on HCBS topics
• Document findings and maintain detailed records of provider evaluations
• Analyze data and prepare reports on provider performance and compliance
• Facilitate training sessions and educational workshops for providers
• Collaborate with stakeholders to implement quality improvement initiatives
• Monitor provider progress in meeting quality standards
• Stay current with evolving HCBS regulations and best practices

Learning and Development

• Collaborate with client to identify training needs and create or procure training for direct support professionals, and/or case managers.
• Serve as liaison with internal and external customers to ensure projects, plans, and/or products are completed satisfactorily.
• Serve as a representative of the Company at external client meetings.
• Promote company expertise and solutions to prospective clients.
• Partner with team members and internal/external customers as necessary, to determine and evaluate methods to encourage participation in the quality improvement and/or special project initiatives.
• Maintain positive relationships with internal and external clients to ensure continued participation.
• Monitors project expenses to ensure alignment with budget.

Quality Improvement Manager – Utilization Management

Lead Marketing and Communications Consultant

Lead Marketing and Communications Consultant

Part-Time Client Service Specialist

Client Service Specialist

Registered Nurse – Care Manager

Home and Community Based Services Specialist

Home and Community Based Services Specialist

Home and Community Based Services Specialist

Program Training Specialist – LTSS