RN Reviewer/ Workers' Compensation Utilization Review - REMOTE in Washington, District of Columbia at MICHIGAN PEER REVIEW ORGANIZATION

iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.

BENEFITS:

• Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.
• Professional Recognition: Join a network of highly respected experts in your specialty.
• Competitive Compensation: Receive fair pay for your time and expertise.
• Protect Standards of Care: Help uphold the integrity of your profession.
• Work Remotely: Review cases from the convenience of your home or office.

• Active, unrestricted RN license required; New York RN license strongly preferred.
• Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health.
• Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria.
• Strong clinical assessment, critical thinking, and written communication skills.
• Experience reviewing medical records and determining medical necessity preferred.

• Review treatment requests and medical records for medical necessity and guideline compliance.
• Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements.
• Prepare clear, objective, and timely review determinations.
• Maintain confidentiality and comply with HIPAA and other applicable privacy requirements.

• Reliable high-speed internet/Wi-Fi connection.
• Secure home office environment with the ability to protect confidential information.
• Proficiency using web-based review platforms and Microsoft Office applications.

OTHER REQUIREMENTS:

• Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.
• Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.
• Active hospital medical staff privileges may be required, as applicable.
• Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.

EOE/VET/Disability