Independent Review Nurse – Part Time

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

📋 Description

• Conduct independent clinical evaluations to support medical management, utilization review, external review, quality review, and various healthcare review initiatives.

• Examine medical records and accompanying documentation to arrive at objective, clinically sound conclusions.

• Complete designated case reviews accurately and within stipulated turnaround times.

• Manage incoming review tasks effectively, prioritizing and handling multiple cases at once.

• Accurately document review outcomes in electronic case management systems and online platforms.

• Draft clear, concise, and well-supported written conclusions.

• Ensure that outgoing review documentation is thorough, precise, and submitted within the required contractual timelines.

• Adhere to HIPAA, CMS, URAC, FISMA, and other relevant regulatory standards.

• Engage in quality assurance activities, audits, and ongoing training initiatives.

• Collaborate effectively with internal teams while upholding reviewer independence and objectivity.

• Assist with additional review tasks and projects as necessary to meet business requirements.

• Commit to working 20 hours per week during standard business hours, Monday through Friday, Eastern Time, with potential for additional hours as needed.

⛳️ Requirements

• A Bachelor's degree in nursing.

• A current, unrestricted Registered Nurse (RN) license in any U.S. state (or as specified by contract).

• At least three (3) years of clinical nursing or related healthcare experience.

• Experience in reviewing medical records and clinical documentation.

• Strong clinical assessment and critical thinking abilities.

• Excellent verbal communication skills.

• Outstanding written communication skills, including experience with documentation in APA format.

• Exceptional attention to detail and strong organizational skills.

• Capability to manage multiple priorities while consistently meeting deadlines.

• Strong customer service skills and professional communication abilities.

• Ability to work independently in a remote setting.

• Capacity to consistently meet assigned schedules and contractual turnaround times.

• Flexibility to work additional hours, evenings, weekends, or holidays as needed.

• Reliable high-speed internet connection.

• A secure professional home office environment that supports confidentiality and productivity.

• Preferred experience in utilization management, utilization review, case management, external review, or medical necessity review.

• Preferred experience applying evidence-based clinical guidelines and regulatory standards.

• Preferred experience with electronic case management systems and healthcare portals.

• Proficiency in Microsoft Office, electronic medical record systems, case management systems, web-based healthcare platforms, project management tools like Asana, and standard remote collaboration tools.

🏝️ Benefits

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

• Emphasis on work/life balance.

• Opportunities for professional development and continuing education.

• Comprehensive medical insurance.

• Dental insurance coverage.

• Vision insurance options.

• Life insurance benefits.

• Short-term disability coverage.

• Long-term disability coverage.

• Generous 401(k) matching program.

• Flexible part-time work schedule.

• A collaborative team-oriented environment.