RN Senior Review Coordinator PT - Saturday's and Sunday's

As a Senior Review Coordinator RN , 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 role is a home based role and is part time working Saturdays and Sundays under 20 hours. What you'll do: You will perform prospective, concurrent or retrospective utilization review/medical management for all services. You will review for appropriateness of care based on contract, state, or URAC requirements You will screen individual situations according to specific criteria to determine if care is appropriate You will refer cases that fail to meet screening criteria to peer reviewer You will coordinate and participate in peer-to-peer review as warranted With prior management approval, you may deviate from criteria with proper justification to authorize the service You will serve as liaison between peer reviewer, provider, facility and/or subscriber You will coordinate and participate in appeal process as directed by management You will 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 You will perform preliminary research on topics such as experimental or cosmetic services, coverage determinations, coding o