RN/Utilization Review – 1099 Contractor (Remote)

Who We Are - Motivated by Purpose. Powered by Clinical Expertise. Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. POSITION OVERVIEW We are seeking a qualified and detail-oriented Registered Nurse (RN) for a PRN (1099 Contractor) Case Reviewer position. The role involves completing a minimum of approximately 100 cases per month, with an expectation of working 15 hours per week. This is a paid per-case position, with a quality expectation of 95% or better. You will be responsible for reviewing cases in a timely manner and responding to supervisor correspondence within 48 hours. Roles:

• To provide objective clinical utilization and peer review activities as requested by the company for cases submitted for independent external review.
• Outreach to provider offices for additional information or determination notification as required.
• To provide objective clinical utilization management and peer review services as requested by the company for standard cases.
• To provide input and feedback and/or general comments to the company as requested

Major Responsibilities or Assigned Duties:

• Complete a minimum of approximately 100 cases per month (~15 hours per week).
• Maintain a 95% or better quality in case completion.
• Respond to supervisor correspondence within 48 hours.
• Will need to use your own computer and internet to perform the work.
• Demonstrate strong attention to detail and ensure accuracy in all cases reviewed.
• To carry out the terms and conditions of the Master Agreement between reviewer and company
• To carry out the policies and procedures as documented in the Reviewer Handbook and Code of Conduct
• To be familiar with the laws, regulations and accreditation standards that govern the activities of the company
• To be familiar with the legal and regulatory issues and requirements applicable for the company’s independent external review activities
• To complete initial company orientation and training activities
• To actively participate in ongoing company and/or client training and education programs at least annually.
• To actively participate in the company’s quality management and quality improvement activities related to the clinical review process

Requirements

Skills and Experience:

• Minimum of 3 years' experience in Emergency Room, Urgent Care, Critical Care, Medical/Surgical, or a combination of these areas.
• Utilization Management experience is preferred.
• Ability to comprehend and communicate effectively through written text.
• Strong attention to detail and ability to meet quality standards.
• Designated workstation with access to a reliable internet connection and a laptop/desktop, monitor, keyboard, and mouse

Education:

• High school diploma or equivalent
• Current, unrestricted Compact Registered Nurse license.

Note: This is a remote, PRN (1099 Independent Contractor) position requiring independent work and self-sufficiency. Work Environment: Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home). Diversity Statement: Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for work without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected].

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