About the Role:
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.

Key Responsibilities:

• Manage the full lifecycle of IRO and UR cases, from intake through final determination and closure
• 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
• Review clinician determinations for accuracy, completeness, and alignment with clinical guidelines and regulatory requirements
• 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

Qualifications:

• 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

Required Experience:

• Background in healthcare appeals, utilization review, case management, or related expertise
• Experience reviewing clinical documentation for quality and completeness
• Experience working with Independent Review Organizations (IROs) preferred

Work Schedule & Environment:

• Fully remote position
• Evening and weekend hours required as needed to meet regulatory deadlines
• Independent, self-directed work with collaboration across clinical and administrative teams

Equal employer – RediMinds contracts with independent physicians without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.