CONTINGENT - IDR/IIDR REVIEWER - REMOTE
About The Position
We are seeking a detail-oriented and knowledgeable Independent Review Specialist to support our IDR/IIDR case review processes on a contingent bases. In this role, you will complete independent dispute resolution reviews in accordance with contractual requirements while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) and URAC Independent Review Organization (IRO) standards. This position plays a critical role in delivering high-quality, timely, and compliant case reviews in a fast-paced healthcare environment. Candidates need to be available on an as needed basis up to 10 hours per week.
Requirements
- Experience in long-term care, assisted living, ICF/IID facilities, or related healthcare settings
- Knowledge of state and federal regulations governing healthcare facilities and services
- Experience with utilization review, case management, or healthcare review processes preferred
- Background in nursing, social work, life safety codes, or CMS surveyor training is highly desirable
- Strong analytical, problem-solving, and organizational skills
- Ability to manage multiple priorities and meet deadlines
- Bachelor’s degree or equivalent experience in utilization review, case management, or healthcare field required
- Strong written and verbal communication skills
- Ability to clearly present complex or technical information
- Skilled at drafting concise, accurate documentation
- Proficiency in Microsoft Office (Word, Excel, Outlook)
- Ability to analyze complex cases and apply sound judgment
- Strong attention to detail and accuracy
- Effective problem-solving and decision-making skills
Nice To Haves
- Nursing or related licensure preferred but not required
- Relevant healthcare, utilization review, or case management experience preferred
- Working knowledge of PowerPoint, Access, and Visio preferred
Responsibilities
- Complete IDR/IIDR case reviews in accordance with contract requirements and deadlines
- Manage assigned deliverables, ensuring accuracy, quality, and timeliness
- Develop and monitor timelines and work plans for assigned cases
- Perform accurate and timely data entry into CMS systems and internal databases
- Process and manage all incoming and outgoing Conflict of Interest (COI) case reviews
- Ensure secure handling and transmission of sensitive case information
- Maintain compliance with all applicable regulations, including HIPAA, FISMA, URAC, and CMS standards
- Proactively identify and resolve issues that may impact timelines or deliverables
- Communicate effectively with internal teams and stakeholders
- Perform other duties as assigned
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
