Senior Review Coordinator – Utilization Management, RN

Telligen

Senior Review Coordinator responsible for utilization review and medical management. Mentoring team members and conducting reviews in a health management organization.

Posted 7/30/2026full-timeWest Des Moines • Iowa, Oklahoma • 🇺🇸 United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Review and Medical Management, ensuring compliance with state and URAC requirements while effectively coordinating peer reviews and appeals. Proficient in training and mentoring team members to uphold quality standards in healthcare services.

Highest-signal resume keywords

Utilization ReviewMedical ManagementRN LicenseClinical ExperiencePeer Review Coordination

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewMedical ManagementClinical AssessmentQuality of Care EvaluationCompliance Reporting

Soft Skills

MentoringCommunicationCollaborationProblem-Solving

Tools & Technologies

Workflow Documentation System

Certifications & Qualifications

RN License

Industry Keywords

HealthcareURAC RequirementsPeer ReviewCoverage DeterminationsCoding Standards

About the role

Key responsibilities & impact

Perform prospective, concurrent or retrospective utilization review/medical management for all services including appropriateness of quality of care based on contract, state, or URAC requirements.
Screen individual situations according to specific criteria to determine if care is appropriate.
Refer cases that fail to meet screening criteria to peer reviewer.
Coordinate and participate in peer-to-peer review as warranted. With prior management approval, may deviate from criteria with proper justification to authorize the service.
Serve as liaison between peer reviewer, provider, facility and/or subscriber.
Coordinate and participates in appeal process as directed by management.
Train or serve as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames.
Performs preliminary research on topics such as experimental or cosmetic services, coverage determinations, coding or standards of care.
Documents review and special project results in workflow documentation system, ensuring data is accurate and timely.
Assists in compliance reporting.
Performs miscellaneous duties as assigned.

Requirements

What you’ll need

Current RN license that is recognized in the relevant jurisdiction(s) or other certification directly relevant to the type of review performed; Ability to obtain required license(s) in state(s) by timeframe set by business not to exceed 6 months
Current RN license must be unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the Medical Director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer
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 recent experience working in a clinical environment
5% local and/or overnight travel

Benefits

Comp & perks

Commitment to employee ownership
Community involvement
Ingenuity and innovative thinking
Integrity and collaborative environment