Remote RN Reviewer for Workers' Comp Utilization

ADP, Inc.; Washington (District of Columbia); Remote; USD 60,000 - 120,000; Part time

Benefits offered by this job

Make a Difference

Professional Recognition

Competitive Compensation

Protect Standards of Care

Remote work

Job summary

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to perform independent external medical reviews remotely as an independent contractor (1099). The reviewer applies clinical expertise to evaluate cases, ensuring medical necessity and standard of care, supporting care quality and professional integrity.

Active RN license required; NY license preferred. Minimum three years in workers' comp or utilization review, with strong assessment, documentation, and HIPAA

Qualifications

• Active, unrestricted RN license required; New York RN license strongly preferred.
• Minimum three 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.

Responsibilities

• 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.

Skills

Clinical assessment

Critical thinking

Written communication

Education

RN license (unrestricted)

NY RN license preferred

Tools

Microsoft Office

Web-based review platforms

Job description

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to perform independent external medical reviews remotely as an independent contractor (1099). The reviewer applies clinical expertise to evaluate cases, ensuring medical necessity and standard of care, supporting care quality and professional integrity.

Active RN license required; NY license preferred. Minimum three years in workers' comp or utilization review, with strong assessment, documentation, and HIPAA