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Review Case Manager – IRO/UR

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RediMinds

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Location:
United States , Southfield

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Category:
Nursing

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

We are seeking a detail-oriented Review Case Manager to process Independent Review Organization (IRO) and Utilization Review (UR) appeals/requests from start to finish. This role is ideal for someone with strong analytical and writing skills who can ensure clinical determinations are accurate, complete, and compliant with applicable guidelines and regulations.

Job Responsibility:

  • Manage the full lifecycle of IRO and UR cases, from intake through final determination and closure
  • Review clinician determinations for accuracy, completeness, and alignment with clinical guidelines and regulatory requirements
  • Ensure all case documentation meets quality, audit, and compliance standards
  • Collaborate with clinicians, case managers, and regulatory clients to obtain and clarify required information
  • Identify and resolve discrepancies or gaps in clinical reviews and supporting documentation
  • Draft clear, concise, and well-structured decision letters, summaries, and case notes
  • Meet strict turnaround times and regulatory deadlines
  • Maintain accurate case tracking and documentation in internal systems
  • Contribute to quality assurance efforts and process improvement initiatives

Requirements:

  • Bachelor’s degree in healthcare administration, nursing, public health, or a related field or equivalent combination of education and relevant work experience
  • Clinical licensure (e.g., RN, LVN/LPN, or similar) preferred but not required
  • Strong analytical and critical thinking skills, particularly in reviewing clinical determinations
  • Excellent written communication skills with a high level of clarity and professionalism
  • Exceptional attention to detail and organizational skills
  • Ability to manage multiple cases and deadlines in a remote work environment
  • Familiarity with utilization review, appeals processes, and IRO workflows
  • Working knowledge of healthcare regulations and compliance standards
  • Background in healthcare appeals, utilization review, case management, or related expertise
  • Experience working with Independent Review Organizations (IROs) preferred
  • Experience reviewing clinical documentation for quality and completeness

Additional Information:

Job Posted:
May 05, 2026

Employment Type:
Parttime
Work Type:
Remote work
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