Overview
CONTINGENT IDR/IIDR REVIEWER (remote) Jobs in Remote at iMPROve Health
Full Job Description
About iMPROve Health
Come join the iMPROve Health team! iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization. We have been both a Cool Place to Work (Crain’s Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare. As a nonprofit organization, we have more than 35 years’ experience improving healthcare across the continuum of care using evidence-based and data-driven logic. iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers. We also have extensive experience completing thoughtful and impartial utilization reviews, dispute resolution, and peer reviews. Our goal is simple – to help healthcare get better!
This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States. We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities. iMPROve Health offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.
iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare. Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare. It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.
iMPROve Health is an equal employment opportunity employer.
Responsibilities Include:
Completes IDR reviews as assigned within the contractual time frames ensuring services are provided within URAC accreditation Program for Independent Review Organization standards.
Uses time and project management skills to ensure assigned activities are completed in a timely manner and in accordance with contract requirements. Applies problem solving abilities to identify, resolve and/or communicate potential delays or problems in advance of deadlines.
Accurately completes data entry on all case review intake according to contract guidelines and timeframes.
Adheres to all security guidelines for safe transmission of COI case reviews.
Maintains up to date knowledge, training and adherence with all compliance and regulatory requirements for contracts, governmental and compliance regulatory organizations (HIPAA, FISMA, URAC, CMS).
Qualifications:
At least 5 years of previous surveyor experience is required
Candidates must have relevant experience and knowledge in long-term care and/or; assisted living facilities; and/or ICF/IID facilities; and/or other health care services of the applicable State and Federal regulations for the referenced facilities and/or providers.
The individual performing the reviews must have regulatory expertise and experience in areas that include nursing and/or social work and/or life safety codes and/or CMS state surveyor training.
Bachelor’s Degree or equivalent years of experience in utilization review or case management experience required
Nursing or related licensure and accreditation with continuing education preferred
Utilization and/or healthcare and/or case management experience preferred
Excellent communication skills
Excellent customer service skills
Title: CONTINGENT IDR/IIDR REVIEWER (remote)
Company: iMPROve Health
Location: Remote
Category:
