IDR Nurse Reviewer

About the role

The IDR Nurse Reviewer supports independent dispute resolution processes at both Federal and State levels. Working within Commence’s data‑centric healthcare environment, the reviewer analyses medical records, ensures proper documentation, and conducts quality‑assurance checks to help determine final outcomes for claim disputes.

Key responsibilities

• Perform initial assessments of documentation from initiating and responding parties.
• Identify missing documents, request needed information, and follow procedures to obtain it.
• Determine the appropriate clinical reviewer (e.g., medical coder or physician) for each case.
• Prepare case files and instructions for arbitrator reviewers.
• Collaborate with legal teams to facilitate dispute resolution.
• Draft professional determination correspondence free of grammatical errors.
• Conduct quality‑assurance checks on determinations according to Federal or State guidance.
• Audit and analyze patient records to ensure accurate determinations.
• Stay current with regulatory changes and perform case‑by‑case research.

Required profile

• Experience reviewing medical records and supporting claim dispute processes.
• Strong understanding of Federal and State healthcare regulations.
• Ability to produce clear, well‑supported rationales for decisions.
• Excellent written communication and attention to detail.
• Capacity to work efficiently, promptly, and courteously while maintaining professionalism.

Required skills