Independent Review Nurse

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iMPROve Health

WebsiteLinkedInAlle Stellen

51 - 200 Mitarbeiter

Gegründet 1984

🏥 Gesundheitswesen

⚕️ Krankenversicherung

💼 Beratung

Healthcare • Healthcare Insurance • Consulting

iMPROve Health ist eine nationale, vollständig remote arbeitende Organisation, die sich auf Qualitätsverbesserung im Gesundheitswesen und Überprüfungsdienstleistungen spezialisiert hat. Seit etwa 40 Jahren bietet sie unabhängige medizinische Begutachtungen, Nutzungsüberprüfungen, Unterstützung von Medicare- und Medicaid-Programmen, Forschungsmethoden, Datenanalysen, Outreach-Strategien und Streitbeilegungen (einschließlich der unabhängigen Streitbeilegung nach dem No Surprises Act) an. Die Organisation ist seit mehr als 20 Jahren URAC-akkreditiert, eine zertifizierte unabhängige Streitbeilegungsstelle, und bietet QI-Lösungen, Peer-Reviews sowie verwandte Beratungsdienstleistungen für Gesundheitsakteure in mehreren Bundesstaaten an.

Beschreibung

• Perform independent clinical reviews according to 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 within required turnaround times • Prioritize incoming review assignments and manage multiple cases simultaneously • Document review findings in electronic case management systems and web-based portals • Prepare clear, concise, well-supported written determinations • Ensure outgoing review documentation is complete, accurate, and submitted by contractual deadlines • Maintain compliance with HIPAA, CMS, URAC, FISMA, and other applicable regulatory requirements • Participate in quality assurance activities, audits, and ongoing training • Collaborate with internal teams while maintaining reviewer independence and objectivity • Assist with additional review activities and projects as business needs require

🎯 Anforderungen

• Bachelor's degree in nursing • 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 • Excellent verbal communication skills • Excellent written communication skills, including experience documenting in APA format • 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 • Ability to consistently work 20 hours per week during assigned schedules and contractual turnaround times • Flexibility to work additional hours, evenings, weekends, or holidays as required • Reliable high-speed internet access • Secure professional home-office workspace supporting confidentiality and productivity • Experience with Microsoft Office: Word, Excel, Outlook, PowerPoint, and Teams • Familiarity with electronic medical record and case management systems • Familiarity with web-based healthcare portals • Familiarity with project management tools such as Asana • Preferred: experience in utilization management, utilization review, case management, external review, or medical necessity review • Preferred: experience applying evidence-based clinical guidelines and regulatory requirements • Preferred: experience with electronic case management systems and healthcare portals

🏖️ Vorteile

• Work/life balance • Professional development opportunities • Continuing education opportunities • Medical insurance • Dental insurance • Vision insurance • Life insurance • Short- and long-term disability coverage • Generous 401(k) match • Flexible remote work arrangement • Collaborative team environment