Independent Review Specialist
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Job Summary
Seeking a detail-oriented Independent Review Specialist for a contingent, remote position to conduct independent dispute resolution reviews, ensuring compliance with CMS and URAC standards while managing case reviews and documentation in a fast-paced healthcare environment.
Key Responsibilities
- Conduct objective reviews of IDR/IIDR cases involving healthcare regulatory citations
- Develop clear, evidence-based written recommendations within established deadlines
- Maintain confidentiality and comply with HIPAA, CMS, and URAC requirements
Required Qualifications
- Bachelor's degree or equivalent experience in utilization review, case management, or healthcare field required
- Experience in long-term care, assisted living, or related healthcare settings
- Knowledge of state and federal regulations governing healthcare facilities and services
- Background in nursing, social work, or CMS surveyor training is highly desirable
- Experience with utilization review or healthcare review processes preferred
Complete Job Description
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