Case Reviewer

About the role

Are you ready for your next career adventure?! Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Case Reviewer to join our healthcare consulting practice. The role is fully remote within the US, with quarterly travel to Columbia, MD for training. We are proud of our national presence, and excited to offer great career opportunities within the organization. 

As a Case Reviewer, you will play a critical role in our Utilization Management department. You will be responsible for performing utilization review and medical management of prior authorizations for plans of service. This position requires a meticulous approach to evaluating medical necessity, appropriateness, and efficiency of healthcare services, procedures, and settings under the provisions of each patient’s benefits.

What you'll do

• Utilization Review: Conduct thorough reviews of prior authorization requests to determine medical necessity and compliance with established guidelines and criteria
• Medical Management: Assess and manage the appropriateness of healthcare services, ensuring they align with evidence-based practices and organizational policies
• Collaboration: Work closely with participant supports, and internal teams to facilitate effective communication and resolution of authorization requests
• Documentation: Maintain accurate and detailed records of all reviews and decisions, ensuring compliance with regulatory requirements and organizational standards
• Education and Training: Stay current with changes in medical guidelines, policies, and regulations.

Qualifications

• Bachelors degree in related field
• Commitment to staying current with changes in medical guidelines, policies, and regulations
• Willingness to participate in ongoing education and training
• Experience or interest in participating in quality improvement initiatives
• Ability to work effectively with a diverse patient population and colleagues
• Strong organizational skills and ability to manage multiple tasks and priorities

Preferred Skills

• Prior Utilization Management knowledge preferred
• Familiarity with Home and Community Based Services (HCBS) waiver programs is a plus
• Durable Medical Equipment (DME) knowledge is a plus
• Good written and oral communication skills are required
• Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems

Integrated Management Strategies is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, gender identity, national origin, disability, pregnancy, status as a protected veteran, or any other protected characteristic as outlined by federal, state, or local laws. If you are an individual with a disability and would like to request a reasonable accommodation for the employment process, please email your request to hr@im-strat.com

E-Verify® is a registered trademark of the U.S. Department of Homeland Security. This business uses E-Verify in its hiring practices to achieve a lawful workforce. www.dhs.gov/E-Verify

The salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary rate for this position will be determined by a number of factors, including, scope, complexity, and location of the role; the skills, education, training, credentials, and experience of the candidate, and other conditions of employment.