About iMPROve Health

Come join the iMPROve Health team! iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization. We are both a Cool Place to Work (Crain’s Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare. As a nonprofit organization, we have more than 35 years’ experience improving healthcare across the continuum of care using evidence-based and data-driven logic. iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews. Our goal is simple – to help healthcare get better!

This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States. We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities.

iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare. Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare. It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.

iMPROve Health is an equal employment opportunity employer.

*We are looking for someone who has flexibility to work on a as-needed/contingent basis during the work week for either 4 or 8 hours for a shift (M-F normal business hours in EST).

SUMMARY:

The Home Help Program review nurse is responsible for the nursing assessments performed for the Home Help program through the Michigan Department of Health and Human Services (MDHHS). These assessments include expanded Home Help services and quality reviews.

For the Home Help program, the registered nurse (RN) reviews selected case records identified by MDHHS and performs assessments on beneficiaries that require a quality review audit for individuals needing help in their homes. These assessments are performed both telephonically and/or virtually via video. Documentation to support the assessment is required.

RNs may be required to represent their review decision at an appeal hearing. These appeals are usually performed telephonically; although, some travel may be necessary.

DUTIES AND RESPONSIBILITIES:

• Performs telephonic or Microsoft Teams assessments for beneficiaries of the Home Help program.
  • Expectation:

-Will appropriately apply nursing skills assessment and chart audit to all selected beneficiaries.

• Utilizes the case management approach to handle telephonic, state selected quality reviews.
  • Expectation:

-Will follow the case from request until completion.

-Will generate the appropriate documentation to be sent on any case.

• Maintains current knowledge of contractual and regulatory requirements.
  • Expectation:

-Will stay current with all MDHHS bulletins, manual changes, or contract updates.

• Assures that reviews are completed timely.
  • Expectation:

-Will complete all reviews within contract timeline as applicable.

• Participate in hearings and appeals.

• Expectation:

-Will represent their review decisions at appeals.

-Will prepare the appeal packet and distribute to required parties.

• Adhere to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).

• Expectations:

-Will maintain up to date knowledge, training and adherence with all compliance and regulatory requirements for contracts, governmental and compliance regulatory organizations.

EDUCATION AND/OR EXPERIENCE:

• Bachelor’s degree in nursing preferred. Equivalent years of experience will be considered.
• Long term care nursing experience required.
• Current Michigan license as an RN required.
• Experience working with State based contracts preferred.
• Three years of utilization and/or health care experience required.
• Strong verbal and written communication skills required, including public speaking.