IDR/IIDR Reviewer – Contingent

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $34 - $42 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 3%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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iMPROve Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1984

🏥 Healthcare

⚕️ Healthcare Insurance

💼 Consulting

Healthcare • Healthcare Insurance • Consulting

iMPROve Health is a national, fully-remote organization that specializes in healthcare quality improvement and review services. For about 40 years it has provided independent medical review, utilization review, Medicare and Medicaid program support, research methodologies, data analysis, outreach strategies, and dispute resolution (including Independent Dispute Resolution under the No Surprises Act). The organization is URAC-accredited for more than 20 years, is a certified independent dispute resolution entity, and delivers QI solutions, peer review, and related consulting services to healthcare stakeholders across multiple states.

📋 Description

• 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 incoming and outgoing Conflict of Interest (COI) case reviews • Securely handle and transmit sensitive case information • Maintain compliance with HIPAA, FISMA, URAC, and CMS standards • Proactively identify and resolve issues affecting timelines or deliverables • Communicate with internal teams and stakeholders • Perform other duties as assigned

🎯 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 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 • Nursing or related licensure preferred but not required • Relevant healthcare, utilization review, or case management experience preferred • 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) • Working knowledge of PowerPoint, Access, and Visio preferred • Ability to analyze complex cases and apply sound judgment • Strong attention to detail and accuracy • Effective problem-solving and decision-making skills • Availability on an as-needed basis for up to 10 hours per week • Flexibility to accept assignments as needed and meet established deadlines and turnaround requirements

🏖️ Benefits

• 100% remote work from anywhere in the United States • Work/life balance • Professional development opportunities • Continuing education opportunities