Case Reviewer

What You'll Do:

Required Skills and Experience:

• Bachelor’s degree in health or human services and/or equivalent experience
• At least 1 year of experience in utilization review or 1 year of experience evaluating, analyzing, researching and developing health care services, policies and programs

Preferred Skills and Experience:

• Knowledge of home and community-based services
• Experience working in an insurance or managed care environment
• Possess Intermediate PC skills including navigating electronic health records and other computer software
• Experience with utilization review of medical services
• Additional information

Who We Are:

Benefits:

• A general description of the benefits and other compensation available for this position can be found in Telligen's Benefits Summary. We’re on a mission to transform lives and economies by improving health. Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success. Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are. Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives. Integrity: We foster a respectful, inclusive, and collaborative environment built on trust 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. While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate. Telligen and our affiliates are Equal Opportunity Employers 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. We will not accept 3rd party solicitations from outside staffing firms. Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class. Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis. If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected]

Responsibilities

• Provides review decisions for prospective reviews based on an established set of criteria
• Screens situations according to specific criteria to determine if care is appropriate
• Refers cases that fail to meet criteria to a Case Manager Supervisor
• Ensures review is conducted thoroughly and within specified timeframes
• Serves as liaison among clinical reviewer, provider, facility and/or subscriber
• Documents medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely
• Ensures quality customer service by responding to email and phone inquiries from providers and consumers
• Performs miscellaneous duties as assigned