About the job
🚨 We’re Hiring: Registered Nurse – Independent Dispute Resolution (IDR)
📍 Remote | 🕘 Monday–Friday, 9:00 AM – 5:00 PM (flexibility available)
📅 Contract indefinite
We are seeking a detail-oriented and experienced Registered Nurse (RN) to support State and Federal Independent Dispute Resolution (IDR) processes. This role plays a critical part in ensuring accurate clinical reviews, fair determinations, and compliance with regulatory requirements.
🔍 Key Responsibilities
- Perform comprehensive clinical reviews through the appeal level, including chart screening and documentation analysis
- Compile regulatory guidance and research payer requirements
- Complete electronic worksheets and prepare final case determinations
- Support Medical Review Analysts and Physician Consultants in the IDR process
- Serve as a resource for clinical and administrative staff, offering guidance and clarification
- Provide training, mentoring, and onboarding support for new RNs
- Participate in team huddles, collaborative trainings, and process improvement initiatives
- Conduct claims assessment and adjudication
- Contribute to additional project activities as needed
✅ Qualifications
- Active New York Registered Nurse (RN) license (required)
- Bachelor’s Degree in Nursing (BSN) or graduate of an approved RN program
- Minimum of 2 years of clinical experience (inpatient or outpatient)
- Experience with electronic medical records (EMR) systems
- Strong analytical, problem-solving, and collaboration skills
- Excellent written and verbal communication
- Ability to work independently in a fast-paced, deadline-driven environment
- Adaptable, flexible, and solutions-oriented mindset
💼 What You’ll Bring
- Clinical expertise combined with strong attention to detail
- Ability to interpret medical documentation and regulatory requirements
- A collaborative approach to working with cross-functional teams
- A passion for ensuring accuracy, fairness, and quality in healthcare determinations
If you’re looking to leverage your clinical expertise in a dynamic, non-traditional RN role, we’d love to connect!
👉 Apply today or message me directly to learn more.
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