IDR/IIDR REVIEWER - REMOTE (Contingent)

Summary:

We are seeking a detail-oriented and knowledgeable Independent Review Specialist to support our IDR/IIDR case review processes on a contingent bases.  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

• 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

Education & Experience

• 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

This is a fully remote opportunity.

EOE/VET/Disability