Medical Review Institute of America, LLC

Compliance

• Staff level position responsible for designated corporate-wide compliance activities in the areas of regulatory compliance and accreditation.
• To support the designated activities of the Compliance Department.
• To provide company-wide support in regulatory compliance and accreditation requirements.
• To support all accreditation and regulatory filings as requested.
• Assist with management of the corporate compliance program components as requested.
• Provide timely updates and open communication with the Vice President, Chief Compliance Officer and Compliance Manager.
• Assist with the provision of staff training on the subjects of regulatory compliance and accreditation standards and maintain documentation of all training.
• Assist with management of the company Learning Management System as requested.
• Support the review process for all corporate policies and procedures as requested.
• Prepare and submit state and accrediting body filings, applications, and reports.
• Prepare, submit, and review monthly exclusions checks on all employees and reviewer contractors.
• Prepare, distribute, and present required compliance reports, submissions, etc., to regulatory and accreditation bodies.
• Assist with providing employee and reviewer orientation and training/continuing education on operational processes regarding compliance with regulatory requirements and accreditation standards as requested.
• Assist with internal and external audits conducted by or through the Compliance department and/or initiated by clients, outside agencies or regulators.
• Gather, review, and analyze data required for such audits.
• Assist with all follow up related to these audits, including internal reporting, monitoring and facilitating corrective action plans and process improvements.
• Ensure compliance with Medicare Part D requirements and Fraud, Waste and Abuse policies.
• Support legal concerns including but not limited to record requests, subpoenas, depositions, and releases of information as requested.
• Assist with investigation and reporting of privacy and security incidents as requested.
• Support all Quality Management initiatives as applicable.
• Participate in the Complaint process as requested.
• Maintain a flexible schedule.
• Participate in all Company meetings and committees as requested.
• Complete other duties and responsibilities as requested.

Compliance Coordinator

Cloud Engineer

• Our Principal Cloud Engineer is a senior technical leader responsible for designing, governing, and optimizing cloud infrastructure and platforms across the organization.
• In this role, you will serve as the organization's senior technical authority for cloud architecture and infrastructure, bringing extensive expertise to establish engineering standards and governance, and to lead complex cloud initiatives from design through delivery.
• Beyond technical leadership, you will mentor and guide the Systems Administration and Information Security teams, ensuring knowledge is shared through documentation, standards, and coaching.
• You will translate complex technical concepts into clear business and operational decisions, provide leadership during critical production events, and set the benchmark for engineering excellence.
• Roles: Serve as the highest-level technical authority and subject matter expert for all Azure cloud infrastructure and architecture
• Define cloud engineering standards, architectural patterns, and governance practices that the organization adopts and follows
• Own and lead cloud infrastructure projects end-to-end — from design and planning through execution, delivery, and post-deployment operations
• Support the Manager of IT & IS on cloud strategy, architecture roadmap, and platform investment decisions
• Mentor and develop the Systems Administration and Information Security teams — building organizational cloud competency through hands-on guidance, deliberate coaching, and knowledge transfer
• Collaborate with Development teams to design and deliver application infrastructure on Azure
• Provide Tier 2/3 escalation support to the IT Help Desk for complex infrastructure and cloud issues
• Partner with the Information Security team to implement and evidence compliance controls for HITRUST 11.3r2 and SOC2

Principal Cloud Engineer – Microsoft Azure

General

• Conduct independent Utilization Reviews
• Work remotely from anywhere in the US
• Adhere to all applicable HIPAA regulations and company policies regarding confidentiality

Child & Adolescent Psychiatrist

Quality Specialist

• partner with key members of leadership for the design and implementation of Quality Management procedures
• ongoing improvement efforts, and other team projects with the aim of achieving organizational, accreditation, and regulatory requirements
• Review and analyze current processes related to the application and implementation of policies, procedures, and practices
• provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements
• Identify gaps in efficient process workflow and suggests steps for quality process improvement
• Measure process performance using valid and accurate methods; analyze trends, variation, and process stability to determine if defined performance metrics are met and identify areas of risk
• lead and support structured quality improvement initiatives (e.g. DMAIC or equivalent)
• Manage and lead Quality Improvement Projects (QIPs)
• Manage and ensure execution of CAPAs, including documented root cause analysis, defined success metrics, implementation tracking, and post-implementation validation demonstrating sustained improvement in coordination with the Clinical Quality, Compliance, and Operations leaders
• Serve as liaison between clients and MRIoA’s quality management department as needed
• Assist leadership in establishing and reporting quality metrics

Healthcare Quality Management Specialist

• partner with key members of leadership for the design and implementation of Quality Management procedures, ongoing improvement efforts, and other team projects
• lead and support structured quality improvement initiatives (e.g., Lean, Six Sigma, DMAIC or equivalent)
• review and analyze current processes related to the application and implementation of policies, procedures, and practices
• provide leadership with recommendations for updates to comply with the current regulatory and accreditation requirements
• identify gaps in efficient process workflow and suggests steps for quality process improvement
• measure process performance using valid and accurate methods
• analyze trends, variation, and process stability to determine if defined performance metrics are met
• manage and lead Quality Improvement Projects (QIPs)
• serve as liaison between clients and MRIoA’s quality management department
• assist leadership in establishing and reporting quality metrics

Quality Management Specialist

Operations

• Manager-level position responsible for end-to-end operational oversight of pharmacy operations supporting both clinical and non-clinical functions
• Accountable for workflow performance, team coordination, and execution across integrated operational models
• Leads cross-functional teams responsible for case progression, clinical review support, and completion activities, ensuring alignment with quality, turnaround time, and productivity expectations
• Partners with clinical leadership, quality, and operations teams to drive efficiency, reduce rework, and support scalable, high-performing operational workflows
• Provide operational leadership for pharmacy operations workflows, including both clinical and non-clinical functions supporting IRO services (initial reviews and appeals)
• Own the execution and performance of integrated pharmacy operations, ensuring alignment across case progression, clinical review support, and completion processes
• Lead cross-functional teams to deliver against key operational metrics, including quality, turnaround time, productivity, and backlog management
• Drive alignment between clinical and non-clinical workflows to ensure efficient case flow, minimize rework, and optimize resource utilization
• Partner with clinical leadership, quality, and operations teams to ensure consistency in review practices, documentation standards, and workflow execution
• Contribute to the ongoing design, refinement, and standardization of operational workflows to support scalability and performance improvement
• Develop team capability through coaching, performance management, and workforce planning across both clinical and non-clinical staff
• Identify operational risks, gaps, and inefficiencies, and implement solutions to improve performance and service delivery
• Lead day-to-day operations of pharmacy workflows, ensuring efficient case progression across clinical and non-clinical functions
• Own performance outcomes for assigned operations, including quality, turnaround time, productivity, and backlog management
• Monitor and manage workflow distribution, capacity, and staffing to ensure alignment with volume demands and service level expectations
• Ensure effective coordination between clinical and non-clinical functions to support seamless case flow and minimize delays or rework
• Identify and resolve operational bottlenecks, inefficiencies, and breakdowns in workflow execution
• Establish and maintain performance standards, ensuring accountability at both individual and team levels
• Provide direct leadership to team members, including coaching, performance management, and development of both clinical and non-clinical staff
• Partner with quality and clinical leadership to ensure consistency in review practices, documentation, and adherence to internal and external standards
• Support implementation and stabilization of new workflows, processes, and operational changes to improve efficiency and scalability
• Analyze operational data and performance trends to identify opportunities for improvement and drive informed decision-making
• Ensure readiness and operational alignment for new clients, products, or workflow changes impacting pharmacy operations
• Maintain effective communication with cross-functional partners to ensure alignment on priorities, risks, and performance outcomes
• Perform other duties as required to support operational performance and business needs

Pharmacy Operations Manager

Frontend Engineer

• staff-level software engineer responsible for designing, developing, and maintaining modern web applications using full-stack technologies
• Develop, maintain, and deploy full-stack web applications
• Build user interfaces using React and modern frontend technologies
• Develop backend services using NodeJS and Python (APIs, microservices)
• Support application hosting, server management, and deployment pipelines
• Utilize AI-assisted coding tools to enhance development efficiency and quality
• Design, implement, test, document, and maintain software applications aligned with coding standards and industry best practices
• Develop scalable APIs and backend services using NodeJS and Python
• Build responsive, accessible UI components using React
• Collaborate with stakeholders to define system scope, requirements, and design solutions
• Document, investigate, prioritize, and resolve software defects
• Monitor, analyze, and enhance application performance and reliability
• Contribute to CI/CD pipelines, automated testing, and DevOps practices
• Research and recommend improvements to tools, frameworks, and development processes
• Ensure adherence to security, privacy (PHI/HIPAA), and compliance standards

Web Developer

Medical Director

• Perform utilization management case reviews.
• Maintain productivity score per company standard.
• Maintain annual quality score per company standard.
• Complete annual inter-rater reliability testing.
• Train across all queues as requested by MRIoA leadership.
• Complete all client specific training as requested by MRIoA leadership.
• Maintain up-to-date records of case completion if required.
• Consistently show willingness to take cases as requested.
• Demonstrate respect in interactions across the company.
• Consistently submit scheduling requests at least three months in advance.
• Consistently work scheduled hours.
• Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
• Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team.
• Actively participate in the MRIoA evaluation process (both company and individual).
• Participate in all company meetings and committees as requested.
• Complete other duties as requested or approved by the CEO and/or chief medical officer.
• Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards

Medical Director – Utilization Management

Pharmacist

• responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming pharmacy review requests
• preparing review information and materials for assignment to appropriate reviewers
• entering pharmacy case review data in the online case summary/tracking system
• receiving and reviewing Reviewer decisions
• completing outreach over the phone to gather additional information for cases
• taking inbound phone calls from medical professionals
• issuing appropriate, timely and accurate review outcome notifications
• completion of pharmacy case review data in the online case summary/tracking system and client system
• To prepare high quality appropriate pharmacy case review information and materials for submission to the reviewers
• To finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
• To serve as a company liaison with clients, reviewers and practitioners/providers/facilities whose services are subject to review
• Screen incoming pharmacy review requests for completeness of materials required to conduct the review of the case
• Prepare, organize, distribute and present records, materials and forms required for a complete pharmacy case review by reviewers
• Identify appropriate reviewers for pharmacy case review assignment including: determine their availability for a review assignment and obtain information for delivery of the case to the Reviewer if applicable
• Contact clients to resolve questions, obtain information, records and/or materials needed for a pharmacy case review and resolve issues about active cases
• Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
• Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
• Receive incoming phone calls from medical professionals checking status on cases and/or providing additional information to decision cases
• Create and maintain an in-house review file for each active pharmacy case
• Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling as needed
• Research clients’ questions about review processes and/or Reviewer decisions
• Determine the need for additional information or additional review and notify the client and internal departments of these needs
• Support all Quality Management initiatives
• Actively participate in the compliance process and Provider Relations assessment process
• Support all compliance program activities
• Participate in all company meetings and committees as requested
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Adapt to the differences of clients
• Maintain a flexible schedule to meet client needs
• Complete other duties and responsibilities as directed
• Collaborate with and cross-train on other teams as needed