[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.

This is an as-needed contingent position, and work assignments will vary based on business needs and case volume. Candidates must be flexible and available to accept assignments as needed, including meeting established deadlines and turnaround requirements. Candidates need to be available on an as-needed basis up to 10 hours per week.

Key Responsibilities

• Conduct objective reviews of IDR/IIDR cases involving healthcare regulatory citations.
• Review survey findings, facility rebuttals, and supporting documentation.
• Apply applicable state and federal regulations and CMS guidance.
• Develop clear, concise, evidence-based written recommendations within established deadlines.
• Address quality assurance feedback and required revisions timely.
• Facilitate IDR/IIDR conferences professionally within established deadlines.
• Perform accurate and timely data entry into internal databases.
• Complete required Conflict of Interest (COI) disclosures.
• Maintain confidentiality and securely handle sensitive case information.
• Comply with applicable HIPAA, CMS, FISMA, URAC, contractual, and organizational requirements.
• Proactively identify and resolve issues that may impact timelines or deliverables.
• Communicate effectively with internal teams and stakeholders.
• Participate in required training and maintain regulatory knowledge.
• 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 surveyor, healthcare, utilization review, or case management experience preferred.

Skills & Competencies

• Exceptional analytical and critical-thinking skills.
• 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, Adobe 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.