Project Specialist - Healthcare (Remote)

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 offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.

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.

• Must be able to work M-F normal business hours in EST.

SUMMARY:

The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR/IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of all necessary review documentation.

Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve the development of moderately complex spreadsheets, multi-tasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, effective time management and problem-solving skills.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work with team and subject matter expert to close disputes in a timely manner while ensuring case meets established quality standards.
• Develop materials such as forms, detailed correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.
• Collaborate with IDRE team members to achieve department goals including prescreening IDR cases for eligibility using defined criteria.
• Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
• Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review portals.
• Assist the team with facilitating review requests in a timely and efficient manner including implementing processes to track and monitor individual case progress and timeliness.
• Work closely with the administrative assistance to ensure receipt of all review documentation.
• Complete other duties as assigned.
• Ensure compliance with all Company policies.
• Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.

EDUCATION AND EXPERIENCE:

• Strong communication skills, both verbal and written required
• Project Management skills required
• Associate degree or 5 years of related experience required, bachelor's degree preferred (healthcare specialty preferred)
• 2 years of project support experience in a corporate/professional environment required
• Strong multi-tasking skills with attention to details and deadlines required