Remote RN Reviewer for Workers' Comp Utilization Review

Michigan Peer Review Organization; Washington (District of Columbia); Remote; USD 83,000 - 124,000; Full time

Benefits offered by this job

Make a Difference

Professional Recognition

Competitive Compensation

Protect Standards of Care

Work Remotely

Job summary

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis.

As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession.

Qualifications

• 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.

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

RN licensure

Clinical assessment

Medical records review

HIPAA compliance

Education

Registered Nurse license

Tools

Microsoft Office

Job description

iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis.

As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession.