IDR/IIDR REVIEWER - REMOTE (Contingent)

MICHIGAN PEER REVIEW ORGANIZATION•Washington, DC

9d•$34 - $42•Remote

About The Position

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, recognized as a Cool Place to Work by Crain’s Detroit Business and one of Modern Healthcare’s Best Places to Work in Healthcare. As a nonprofit with over 40 years of experience, iMPROve Health is dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. They provide medical consulting and review services, along with data analysis, to various organizations including federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. The team specializes in impartial utilization review, dispute resolution, and peer review, with a mission to improve healthcare. This position is 100% remote, offering flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. iMPROve Health prioritizes work/life balance and invests in employees’ growth through professional development and continuing education opportunities. The company is committed to improving the quality, safety, and efficiency of healthcare. While they do not provide direct patient care, their healthcare professionals partner with providers to promote evidence-based best practices, offering clients a trusted, impartial resource that understands healthcare complexities and is dedicated to high-quality solutions. Join iMPROve Health in making a meaningful impact on healthcare.

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
Bachelor’s degree or equivalent experience in utilization review, case management, or healthcare field required
Strong analytical, problem-solving, and organizational skills
Ability to manage multiple priorities and meet deadlines
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

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
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