INDEPENDENT REVIEW NURSE

About iMPROve Health

Come join the iMPROve Health team!

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, and we’re proud to be recognized as both a Cool Place to Work by Crain’s Detroit Business (four years running) and one of Modern Healthcare’s Best Places to Work in Healthcare.

As a nonprofit with more than 40 years of experience, we’re 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 team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better.

This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees’ growth through professional development and continuing education opportunities. Our benefit package includes medical, dental, vision, life insurance, short- and long-term disability, and a generous 401(k) match.

At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals—including physicians, nurses, and experienced consultants—partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.

Join us in making a meaningful impact on healthcare—one improvement at a time.

About the Role:

iMPROve Health is seeking an experienced and detail-oriented Registered Nurse to join our team as an Independent Review Nurse (IRNs).

This is a part-time remote position requiring a consistent commitment of 20 hours per week scheduled during normal business hours (Monday–Friday, Eastern Time), with additional after hours, weekend, and holiday hours, as needed to meet contractual deadlines.

In this role, you will perform independent clinical reviews supporting medical management, utilization review, external review, quality review, and other healthcare review programs. The ideal candidate is an experienced RN with strong clinical judgment, exceptional analytical skills, and the ability to make objective, evidence-based determinations while working in a fast-paced remote environment.

This position requires excellent time management, accuracy, and a commitment to meeting contractual turnaround times while maintaining compliance with regulatory and accreditation requirements.

Schedule

• Part-time position requiring 20 hours per week
• Standard business hours are Monday through Friday
• Candidates must be able to consistently meet assigned schedules and contractual turnaround times
• Flexibility to work additional hours, evenings, weekends, or holidays is required to meet contractual deadlines and business needs

What You'll Do

As an Independent Review Nurse, you will:

• Perform independent clinical reviews in accordance with contract requirements, evidence-based guidelines, and regulatory standards.
• Review medical records and supporting documentation to make objective, clinically sound determinations.
• Complete assigned case reviews accurately and within required turnaround times.
• Prioritize incoming review assignments and manage multiple cases simultaneously.
• Document review findings accurately in electronic case management systems and web-based portals.
• Prepare clear, concise, and well-supported written determinations.
• Ensure outgoing review documentation is complete, accurate, and submitted within contractual deadlines.
• Maintain compliance with HIPAA, CMS, URAC, FISMA, and other applicable regulatory requirements.
• Participate in quality assurance activities, audits, and ongoing training.
• Collaborate effectively with internal teams while maintaining reviewer independence and objectivity.
• Assist with additional review activities and projects as business needs require.

Qualifications

Required

• Bachelor's degree in nursing
• Excellent verbal communication skills.
• Excellent written communication skills, to include experience documenting in APA format.
• Current, unrestricted Registered Nurse (RN) license in any U.S. state (or as required by contract).
• Minimum of three (3) years of clinical nursing or related healthcare experience.
• Experience reviewing medical records and clinical documentation.
• Strong clinical assessment and critical thinking skills.
• Exceptional attention to detail and organizational skills.
• Ability to manage multiple priorities while consistently meeting deadlines.
• Strong customer service and professional communication skills.
• Ability to work independently in a remote environment.

Preferred

• Experience in utilization management, utilization review, case management, external review, or medical necessity review.
• Experience applying evidence-based clinical guidelines and regulatory requirements.
• Experience working with electronic case management systems and healthcare portals.

Technical Skills

Candidates should be comfortable using:

• Microsoft Office (Word, Excel, Outlook, PowerPoint, and Teams)
• Electronic medical record and case management systems
• Web-based healthcare portals
• Project management tools such as Asana
• Standard office technology and remote collaboration tools

What Makes You Successful

We're looking for professionals who demonstrate:

• Sound clinical judgment
• Strong analytical and problem-solving abilities
• Excellent written documentation skills
• Accuracy and attention to detail
• Effective time management
• Accountability and reliability
• Ability to adapt to changing priorities
• Commitment to confidentiality and regulatory compliance
• Professionalism and integrity

Work Environment

This position is performed remotely from a professional home office within the United States. Candidates must have reliable high-speed internet access and a secure workspace that supports confidentiality and productivity.

Why Join iMPROve Health?

At iMPROve Health, you'll have the opportunity to make a meaningful impact on healthcare quality and patient outcomes while working with a collaborative team of healthcare professionals. We value integrity, clinical excellence, continuous learning, and a commitment to delivering objective, high-quality review services.

If you're an experienced Registered Nurse who enjoys applying your clinical expertise in a flexible, part-time remote role, we'd love to hear from you.

EOE/VET/Disability