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MICHIGAN PEER REVIEW ORGANIZATION logo
MICHIGAN PEER REVIEW ORGANIZATION

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. Our mission is simple: help healthcare get better.

Independent Review Specialist

Location

United States

Posted

78 days ago

Salary

$34 - $40 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

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.

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