Contingent UR​/LTSS Registered Nurse

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CONTINGENT US

15 days ago Requisition

Salary Range: $36.00 To $42.00 Hourly

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, and we’re proud to be recognized as both a Cool Place to Work by Crain’s Detroit Business (four years running) and one of Modern Healthcare’s Best Places to Work in Healthcare.

As a nonprofit with more than 40 years of experience, we’re dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review.

Our mission is simple:
help healthcare get better.

This position is 100% remote
, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team.

At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals—including physicians, nurses, and experienced consultants—partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.

Join us in making a meaningful impact on healthcare—one improvement at a time.

iMPROve Health is seeking an experienced Michigan-licensed Registered Nurse (RN) to join our team as a Contingent Utilization Review / Long-Term Services & Supports (UR/LTSS) Review Nurse
. This fully remote position supports Michigan Medicaid programs by conducting Nursing Facility Level of Care (LOC) reviews and Home Help quality review assessments.

This role is ideal for experienced nurses with both Utilization Review/Utilization Management (UR/UM) and Long-Term Services & Supports (LTSS)/Long-Term Care experience who are looking for flexible, contingent work while remaining engaged in meaningful clinical practice.

Review nurses evaluate medical records, conduct telephonic and virtual assessments, apply established clinical and regulatory criteria, and ensure timely, accurate review determinations. This position also includes participation in administrative hearings and appeals when necessary.

Contingent nurses are expected to maintain regular availability of at least 4–8 hours per week
, with opportunities for additional hours based on program needs. Most work is performed during normal business hours; however, occasional evening, weekend, or holiday work may be required.

• Perform utilization review activities in accordance with program requirements, contractual obligations, clinical guidelines, and regulatory standards.
• Conduct telephonic Nursing Facility Level of Care (LOC) reviews for Michigan Medicaid beneficiaries using established LTSS criteria.
• Perform verification, secondary, and quality reviews for Long-Term Services & Supports (LTSS) cases.
• Conduct virtual Home Help assessments using Microsoft Teams for beneficiaries selected by the Michigan Department of Health and Human Services (MDHHS).
• Review medical records, assessments, care plans, and supporting clinical documentation to determine eligibility and medical necessity.
• Apply evidence-based clinical criteria and state regulations to support review…