Independent Review Nurse – Part Time

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $35 - $42 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 3%

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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

• 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 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, 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 with internal teams while maintaining reviewer independence and objectivity • Assist with additional review activities and projects as business needs require • Work 20 hours per week during Monday–Friday normal business hours, with additional hours as needed to meet contractual deadlines

🎯 Requirements

• 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 meet assigned schedules and contractual turnaround times • Flexibility to work additional hours, evenings, weekends, or holidays as required • Reliable high-speed internet access • Secure home-office workspace supporting confidentiality and productivity • 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 preferred • Comfort using 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, and standard office technology

🏖️ Benefits

• 100% remote work from anywhere in the United States • Professional development and continuing education opportunities • Medical, dental, and vision insurance • Life insurance • Short- and long-term disability insurance • Generous 401(k) match • Flexible part-time schedule • Collaborative team environment • Work/life balance

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