INDEPENDENT REVIEW NURSE

MICHIGAN PEER REVIEW ORGANIZATION• REMOTE, US,

4d•$34 - $40•Remote

About The Position

iMPROve Health is seeking an experienced and detail-oriented Registered Nurse to join their team as an Independent Review Nurse (IRN). This is a part-time remote position requiring a consistent commitment of 20 hours per week scheduled during normal business hours (Monday–Friday, Eastern Time), with additional after hours, weekend, and holiday hours, as needed to meet contractual deadlines. In this role, you will perform independent clinical reviews supporting medical management, utilization review, external review, quality review, and other healthcare review programs. The ideal candidate is an experienced RN with strong clinical judgment, exceptional analytical skills, and the ability to make objective, evidence-based determinations while working in a fast-paced remote environment. This position requires excellent time management, accuracy, and a commitment to meeting contractual turnaround times while maintaining compliance with regulatory and accreditation requirements.

Requirements

Bachelor's degree in nursing
Excellent verbal communication skills.
Excellent written communication skills, to include experience documenting in APA format.
Current, unrestricted Registered Nurse (RN) license in any U.S. state (or as required by contract).
Minimum of three (3) years of clinical nursing or related healthcare experience.
Experience reviewing medical records and clinical documentation.
Strong clinical assessment and critical thinking skills.
Exceptional attention to detail and organizational skills.
Ability to manage multiple priorities while consistently meeting deadlines.
Strong customer service and professional communication skills.
Ability to work independently in a remote environment.
Microsoft Office (Word, Excel, Outlook, PowerPoint, and Teams)
Electronic medical record and case management systems
Web-based healthcare portals
Project management tools such as Asana
Standard office technology and remote collaboration tools

Nice To Haves

Experience in utilization management, utilization review, case management, external review, or medical necessity review.
Experience applying evidence-based clinical guidelines and regulatory requirements.
Experience working with electronic case management systems and healthcare portals.

Responsibilities

Perform independent clinical reviews in accordance with contract requirements, evidence-based guidelines, and regulatory standards.
Review medical records and supporting documentation to make objective, clinically sound determinations.
Complete assigned case reviews accurately and within required turnaround times.
Prioritize incoming review assignments and manage multiple cases simultaneously.
Document review findings accurately in electronic case management systems and web-based portals.
Prepare clear, concise, and well-supported written determinations.
Ensure outgoing review documentation is complete, accurate, and submitted within contractual deadlines.
Maintain compliance with HIPAA, CMS, URAC, FISMA, and other applicable regulatory requirements.
Participate in quality assurance activities, audits, and ongoing training.
Collaborate effectively with internal teams while maintaining reviewer independence and objectivity.
Assist with additional review activities and projects as business needs require.