Remote IDR/IIDR Review Specialist

iMPROve Health - MICHIGAN PEER REVIEW ORGANIZATION; United States; Remote; USD 47,000 - 58,000; Full time

Job summary

iMPROve Health is seeking an Independent Review Specialist to support IDR/IIDR case reviews on a contingent basis. The role requires completing reviews in line with CMS and URAC standards while maintaining timeliness and accuracy.

This 100% remote position offers flexible assignments across the United States, with potential for varied case volumes and deadlines. Ideal candidates will have healthcare utilization review or case management experience and strong documentation skills.

Qualifications

• Bachelor’s degree or equivalent in utilization review, case management, or healthcare field.
• 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.
• Strong written and verbal communication skills.
• Ability to clearly present complex or technical information.

Responsibilities

• 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 all incoming and outgoing Conflict of Interest (COI) case reviews.
• Ensure secure handling and transmission of sensitive case information.
• Maintain compliance with HIPAA, FISMA, URAC, and CMS standards.
• Proactively identify and resolve issues that may impact timelines or deliverables.
• Communicate effectively with internal teams and stakeholders.
• Perform other duties as assigned.

Skills

Analytical skills

Problem-solving

Time management

Organizational skills

Education

Bachelor's degree in healthcare/utilization review

Nursing licensure preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft PowerPoint

Microsoft Access

Microsoft Visio

Job description

iMPROve Health is seeking an Independent Review Specialist to support IDR/IIDR case reviews on a contingent basis. The role requires completing reviews in line with CMS and URAC standards while maintaining timeliness and accuracy.

This 100% remote position offers flexible assignments across the United States, with potential for varied case volumes and deadlines. Ideal candidates will have healthcare utilization review or case management experience and strong documentation skills.