[Hiring] Independent Review Specialist @MICHIGAN PEER REVIEW ORGANIZATION

Role Description

We are seeking a detail-oriented and knowledgeable Independent Review Specialist to support our IDR/IIDR case review processes on a contingent basis. In this role, you will complete independent dispute resolution reviews in accordance with contractual requirements while ensuring compliance with Centers for Medicare & Medicaid Services (CMS) and URAC Independent Review Organization (IRO) standards. This position plays a critical role in delivering high-quality, timely, and compliant case reviews in a fast-paced healthcare environment. Candidates need to be available on an as-needed basis up to 10 hours per week.

Key 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 all applicable regulations, including 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

Qualifications

• 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
• Background in nursing, social work, life safety codes, or CMS surveyor training is highly desirable
• Strong analytical, problem-solving, and organizational skills
• Ability to manage multiple priorities and meet deadlines

Requirements

• Bachelor’s degree or equivalent experience in utilization review, case management, or healthcare field required
• Nursing or related licensure preferred but not required
• Relevant healthcare, utilization review, or case management experience preferred

Skills & Competencies

• Strong written and verbal communication skills
• Ability to clearly present complex or technical information
• Skilled at drafting concise, accurate documentation
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Working knowledge of PowerPoint, Access, and Visio preferred
• Ability to analyze complex cases and apply sound judgment
• Strong attention to detail and accuracy
• Effective problem-solving and decision-making skills

Benefits

• This is a fully remote opportunity.

Company Description

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers.