Jobs at IPRO

Conduct utilization, quality, clinical study, and appeal-level reviews using medical records and electronic worksheets. Make level-one denial decisions, collect clinical data, support Medical Review Analysts and Physician Consultants, and assist administrative staff with training, problem-solving, procedures, technical guidance, and staff huddles. The role requires a New York State RN license, nursing education, and acute-care or utilization-review experience.

Conduct utilization and quality reviews, including admission screening, authorizations, discharge and waiver processing, concurrent and retrospective reviews, appeals, and clinical study data collection. Support medical review analysts and physician consultants, collaborate on mental health reporting, and assist administrative staff with training, problem-solving, and procedure clarification.

Performs complex healthcare data analyses, including MCO encounter data validation, quality assurance, and performance measurement. Develops queries, reports, and Tableau dashboards; translates business requirements into analytical solutions; and communicates results to clients and stakeholders. Identifies automation and workflow improvements while ensuring data accuracy, regulatory compliance, and timely deliverables. Supports HEDIS and CMS-related analytics and manages multiple projects in an office-based environment.

Supervise claims specialists reviewing provider and health plan documentation for Federal IDR eligibility. Manage workflows, productivity, quality, staffing, onboarding, training, performance evaluations, records, and reporting. Resolve customer concerns, address production issues, lead meetings, implement process improvements, and escalate issues to management. The role requires familiarity with CMS Federal IDR billing rules and experience in claims review, medical billing, auditing, appeals, dispute resolution, and Independent Dispute Resolution.

Conducts clinical reviews and Federal Independent Dispute Resolution case determinations, manages reviewer workflows and appeals, oversees quality and deadlines, trains RNs, approves administrative items, sets performance goals, and communicates with customers regarding case scenarios, concerns, and directives.

Conducts healthcare data collection, validation, analysis, reporting, dashboard development, root-cause analysis, program evaluation, predictive modeling, and AI/ML work. Collaborates with stakeholders to define requirements, improve business outcomes, connect complex healthcare data sources, and communicate findings through reports, visualizations, and recommendations. Manages multiple projects while delivering accurate, timely results.

Assists leadership with NYSDOH AIDS Institute clinical review planning, staffing, training, quality assurance, clinical research, performance monitoring, and contract compliance. Supervises clinical review staff, supports medical record abstraction and technology-enabled review processes, tracks deliverables, and communicates findings and recommendations to organizational leadership. Requires an NYS RN license, nursing bachelor’s degree, and at least three years of supervisory, managerial, or recent clinical experience.

Performs complex data analyses, develops reports, dashboards, models, and statistical solutions, and communicates findings to technical and nontechnical audiences. The role produces written summaries and presentations, supports quality improvement, manages multiple projects, represents analytics leadership with clients, and serves as a technology expert and resource for junior staff. Responsibilities include improving analytics efficiency and delivering accurate outputs on schedule.

Administer Moodle, build and update online courses, develop digital and print communications, manage social media content, update websites, and support newsletters. Perform Section 508 remediation and apply WCAG accessibility practices to training and communications materials. Collaborate with subject matter experts and cross-functional teams, provide LMS support, track projects, monitor engagement metrics, document workflows, and contribute to communications strategies and special initiatives.

Provides comprehensive executive and administrative support to the CEO and senior leadership, including confidential information management, calendar and travel coordination, correspondence, meetings, minutes, board election support, document safeguarding, initiative tracking, and stakeholder communications. Requires strong organization, discretion, communication, project management, healthcare administration knowledge, and advanced proficiency with Microsoft Office and virtual meeting platforms.

Reviews independent review requests using regulatory criteria and clinical expertise to assess medical necessity and quality of care. Prepares case summaries and physician review questions, evaluates physician determinations, ensures concerns are addressed, and drafts correspondence for contractors, providers, and beneficiaries. The role requires an RN license, strong clinical reasoning, utilization and quality review experience, and proficiency with EHR and Microsoft applications.

Provides clerical and data support for hospital review departments. Responsibilities include coordinating monitoring notifications, tracking forms and charts, preparing review documentation, maintaining files and logs, typing physician consultant responses, screening hospital calls, and supporting department workflow. The role requires professional communication, accurate data entry and typing, organization, customer service, and familiarity with medical terminology. This is an on-site position in Jericho, New York.

Manages payment reconciliation, remittance matching, refund administration, transaction reporting, dispute closure, and financial recordkeeping for Federal Independent Dispute Resolution operations. Researches unmatched payments and discrepancies, maintains audit trails, supports ACH vendor setup, responds to stakeholder inquiries, and partners with Accounting. Ensures compliance with financial controls, internal deadlines, and CMS requirements while supporting audits and process improvements.

Provides comprehensive executive and operational support to the Senior Vice President and Chief Strategy Officer. Responsibilities include managing information flow, coordinating proposals, quality initiatives, communications, training registrations, surveys, meetings, special projects, corporate email triage, and executive group support. The role also conducts market research, prepares reports, liaises with stakeholders, maintains training records, and serves as backup to the CEO’s Special Assistant.

Conducts clinical reviews and Independent Dispute Resolution case determinations, including documentation screening, case summaries, adequacy assessments, insurer requirement research, decision templates, appeals, and final determinations. Supports staff training, problem solving, and clarification of decisions while mentoring new RNs. The role requires managing cases independently and meeting strict deadlines in an in-office environment.

Reviews and validates medical coding, including DRG, CPT, HCPCS, and ICD-10 codes, against national standards and regulations. Prepares independent dispute resolution reviews for state and federal agencies, supports reporting requirements and agency projects, and provides subject matter expertise. The role requires handling confidential clinical and claims data, collaborating with technical and healthcare personnel, and working onsite in Jericho, New York.

Coordinates clinical review and claims projects by monitoring appeals, eligibility, cases, deliverables, deadlines, and performance metrics. Manages provider and contractor communications, identifies process barriers, recommends solutions, presents project status, schedules meetings, documents decisions, and prepares case-related invoices while coordinating payment tracking with Finance and Accounting.

Implements and monitors healthcare quality improvement strategies across hospitals, nursing homes, home health, hospice, dialysis, and physician practices. Builds partnerships, facilitates learning networks, provides technical assistance on root cause analysis, tracks provider interventions, monitors clinical outcomes, prepares reports, delivers presentations, coordinates education, and collaborates with data analysts and healthcare stakeholders to improve care quality, safety, efficiency, and transitions across the healthcare continuum.