RN Reviewer, Workers' Compensation Utilization Review

🔥 19 hours ago

☕ Washington – Remote

☕ Washington – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

👻 Ghost score 14%

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

• Perform independent external medical reviews remotely on an ad hoc basis as an independent contractor • Evaluate workers' compensation cases within the reviewer’s specialty for medical necessity and/or standard of care • Review treatment requests and medical records for medical necessity and guideline compliance • Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements • Prepare clear, objective, and timely review determinations • Maintain confidentiality and comply with HIPAA and other applicable privacy requirements

🎯 Requirements

• Active, unrestricted RN license required • New York RN license strongly preferred • Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health • Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria • Strong clinical assessment, critical thinking, and written communication skills • Experience reviewing medical records and determining medical necessity preferred • Reliable high-speed internet/Wi-Fi connection • Secure home office environment capable of protecting confidential information • Proficiency using web-based review platforms and Microsoft Office applications • Must complete the electronic credentialing application and receive organizational approval before performing a case review • Must complete a conflict of interest attestation upon credentialing and before performing a case review • Active hospital medical staff privileges may be required, as applicable • Must notify the organization promptly of adverse changes in licensure or certification status, including board certification status

🏖️ Benefits

• Use clinical knowledge to improve the quality of care patients receive • Join a network of highly respected experts in your specialty • Competitive compensation based on credential and specialty type • Work remotely from the convenience of your home or office • Protect the integrity of the nursing profession and standards of care