Consultant-Nurse

Integrated Resources Inc. (IRI) is a professional staffing firm specializing in contract, consulting & full time positions in the area of Information Technology, Life Science and Allied Healthcare. Since its inception in 1996, IRI has continued to grow in size, opportunities, service and quality. Our expert team of highly trained counselors work hand in hand with every candidate and client forming a partnership of understanding and commitment.

Oversee medical survey and/or investigation teams, and participate in surveys or investigations if needed Prepare to survey (audit) managed healthcare plans in utilization management, emergency services, pharmacy, grievances and appeals, access and availability, and language assistance; prepare for BHI Investigations Review and analyze managed healthcare plan documents, including but not limited to policies, procedures, organizational charts, meeting minutes, training, and job aids. Complete client-developed audit tools Perform detailed analysis, fact-finding, and documentation of evidentiary support for findings. As applicable, perform a detailed case file review to audit whether the plan is performing as indicated in its policies and complete the client-developed tool that walks the surveyor/investigator through clinical and legal requirements Attend pre-onsite meetings with client team to discuss preliminary findings Prepare for and interview plan staff at managed healthcare plan offices or remotely. Lead interviews with plan staff and the client team (team lead, oversight manager, and attorney) to obtain relevant evidence to support findings Complete and update audit tools with information obtained through the site visit or interviews Identify potential plan deficiencies for survey areas/barriers or violations for investigations Request additional documentation and/or interviews, as needed. Draft report of deficiencies for survey area or barriers/violations for investigations Address feedback and/or questions from the client regarding findings in the report Prepare cost estimates Recommend changes to policies and established procedures- Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures Interact with different levels of external and internal customers