Nurse Reviewer – IMR

. Perform clinical reviews to determine whether medical record documentation supports the need for services .

Posted 10/16/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $78,000 - $88,000 per yearWebsite

Key responsibilities & impact

Perform clinical reviews to determine whether medical record documentation supports the need for services
Apply clinical criteria, coverage policies, utilization guidelines, and practice guidelines specific to the applicable contract
Assemble appeal packages for physician review for independent medical review (IMR)
Ensure clinical appropriateness of IMR determination letters
Triage and determine necessity of expedited IMR appeal requests using federal guidelines and state regulations
Perform level-of-care and utilization reviews by analyzing medical records against criteria
Apply critical thinking and decision-making skills while maintaining production goals and quality standards
Assist management with training new reviewers through monitoring, mentoring, feedback, and education
Maintain current knowledge of clinical criteria and/or coding guidelines
Attend training and scheduled meetings
Cross-train to perform reviews of multiple claim types
Collaborate frequently with the team and other company departments

What you’ll need

Active, unrestricted RN license from the United States and in the primary home residency, or active compact multistate unrestricted RN license under the Nurse Licensure Compact (NLC), required
5+ years clinical experience in an inpatient hospital setting required
3+ years utilization review experience or claims auditing preferred
Experience using InterQual criteria required
Ability to multi-task in a fast-paced production environment
Work location within the continental US
High-speed internet connection
Work environment free from distractions
Ability to work during normal business hours
Ability to work extended hours or be on call every other weekend for business needs
May be required to travel at least 10% of the time based on business needs
Ability to complete required CEUs to maintain RN license

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
High-speed internet and distraction-free home work environment required (not a benefit)
Potential travel reimbursement not explicitly stated