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 40 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.

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

**All work must be performed within the United States.

SUMMARY:

This position functions independently while collaborating with internal teams, external customers, and iMPROve Health’s reviewer panel to support all aspects of the credentialing program, peer reviewer management, and technology-driven process improvement. The role is responsible for maintaining the integrity and compliance of the credentialing process in accordance with federal and state regulations, URAC standards, and client contract requirements. It also supports reviewer recruitment, onboarding, and performance monitoring while providing operational and technical assistance to ensure effective use of electronic case management and credentialing systems. The ideal candidate demonstrates strong analytical and organizational skills, exceptional attention to detail, and a high level of proficiency with technology, database management, and digital workflow tools to enhance efficiency, accuracy, and reviewer engagement across all functions.

DUTIES AND RESPONSIBILITIES:

Credentialing and Compliance

• Manage all aspects of the credentialing lifecycle, including initial, recredentialing, expedited, and ongoing monitoring of physician and allied health reviewers in compliance with URAC, state, and internal requirements.

• Prepare for and participate in URAC accreditation visits.

• Verify and maintain reviewer credentials (licensure, board certification, malpractice history, work history, disciplinary actions) and ensure timely renewals to prevent lapses.

• Maintain and update the credentialing database, tracking systems, and reviewer files for committee review, ensuring documentation accuracy and completeness.

• Coordinate and document credentialing committee meetings and related credentialing activities.

Peer Reviewer Support

• Assist with reviewer recruitment, pre-screening, and onboarding, ensuring appropriate documentation and orientation.

• Provide ongoing technical and administrative support to reviewers using electronic case management systems, troubleshooting issues, and coordinating with IT as needed.

• Monitor reviewer performance metrics (timeliness, quality, compliance) and support quality assurance initiatives.

• Maintain open communication with reviewers, providing updates on procedural or technology changes via various forms of communication including, but not limited to, email and newsletters.

Technology and Process Optimization

• Utilize data management, reporting, and automation tools to enhance workflow efficiency, accuracy, and quality.

• Identify and implement technology-driven process improvements and support system updates, rollouts, and testing.

• Generate and present reports on credentialing compliance, reviewer performance, and process metrics for management review.

• Collaborate across departments to resolve technology issues, improve operations, and develop tools such as user manuals and job aids.

• Participate in developing and submitting proposals for new business opportunities, ensuring compliance with requirements and alignment with organizational goals.

• Ensure compliance with HIPAA, FISMA, URAC, CMS, and other applicable regulations.

• Perform other related duties as assigned.

EDUCATION AND/OR EXPERIENCE:

• Bachelor’s degree in healthcare administration, business, information systems, or a related field required; equivalent experience may be considered.
• Strong knowledge of medical terminology, clinical roles, and healthcare regulatory standards (URAC or similar).
• Experience in credentialing (certification preferred), compliance, and healthcare operations required; equivalent experience may be considered.
• Strong analytical, organizational, and problem-solving skills with attention to accuracy and detail.
• Excellent written and verbal communication skills, with the ability to collaborate effectively across departments and with external partners.
• Customer service-oriented with a focus on responsiveness and professionalism in interactions with internal and external stakeholders.
• Ability to manage multiple priorities and adapt to a fast-paced, compliance-driven environment.
• Flexibility to work outside standard business hours when needed.
• Demonstrated integrity, professionalism, and commitment to confidentiality.