IDR/IIDR Reviewer – Contingent

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct IDR/IIDR case assessments in accordance with contractual obligations and timelines.

• Oversee assigned deliverables, ensuring precision, quality, and adherence to schedules.

• Create and track timelines and action plans for designated cases.

• Execute accurate and prompt data entry into CMS systems and internal databases.

• Process and oversee incoming and outgoing Conflict of Interest (COI) case evaluations.

• Securely manage and transmit confidential case information.

• Ensure compliance with HIPAA, FISMA, URAC, and CMS regulations.

• Actively identify and address issues that may impact timelines or deliverables.

• Liaise with internal teams and stakeholders.

• Perform additional tasks as assigned.

⛳️ Requirements

• Experience in long-term care, assisted living, ICF/IID facilities, or similar healthcare environments.

• Understanding of state and federal regulations pertaining to healthcare facilities and services.

• Preferred experience in utilization review, case management, or healthcare review processes.

• A background in nursing, social work, life safety codes, or CMS surveyor training is highly advantageous.

• Strong analytical, problem-solving, and organizational abilities.

• Capability to juggle multiple priorities and meet deadlines.

• A Bachelor’s degree or equivalent experience in utilization review, case management, or the healthcare sector is required.

• Nursing or related licensure is preferred but not mandatory.

• Relevant experience in healthcare, utilization review, or case management is preferred.

• Excellent written and verbal communication skills.

• Ability to clearly convey complex or technical information.

• Proficient in drafting concise and accurate documentation.

• Proficiency in Microsoft Office (Word, Excel, Outlook).

• Familiarity with PowerPoint, Access, and Visio is preferred.

• Capacity to analyze intricate cases and apply sound judgment.

• Strong attention to detail and precision.

• Effective problem-solving and decision-making abilities.

• Availability on an as-needed basis for up to 10 hours per week.

• Flexibility to take on assignments as required and meet set deadlines and turnaround times.

🏝️ Benefits

• 100% remote work opportunity from anywhere in the United States.

• Promotes work/life balance.

• Opportunities for professional development.

• Access to continuing education initiatives.