Clinical Reviewer WA L&I

Qualis Health; Milwaukee (WI); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare consulting firm is seeking a remote Clinical Reviewer RN to support Washington State's Labor & Industries department. This role involves utilizing best practices in care management to ensure patients receive appropriate healthcare services. The ideal candidate will have a strong clinical background and experience in utilization review, working collaboratively with a team to enhance healthcare quality.

Qualifications

• At least 5 years of clinical experience, including ICU and/or ER.
• Current RN license in Washington state.

Responsibilities

• Participate in a multidisciplinary team to improve healthcare quality.
• Apply clinical criteria to determine medical necessity of services.
• Consult with physicians or refer cases as needed.

Skills

Attention to Detail

Independent Work

Collaboration

Education

Degree or diploma in nursing

Tools

MS Office Suite

Job description

Job Requirements: Clinical Reviewer (WA L&I)

Category: Care Management | Location: Remote | Job Level: Mid Career | Position Type: Full-Time/Regular | Years of Experience: Not Applicable

We are seeking a remote Clinical Review RN to join our team supporting Washington State's Labor & Industries department. At Comagine Health, our utilization management best practices ensure that patients receive the right care, in the right setting, at the right time, thereby avoiding the overuse, misuse, and underuse of health services. We provide web-based utilization reviews and targeted review programs based on extensive data analysis.

Due to contractual requirements for RN reviewer coverage until at least 5:00 pm Pacific Time, nurses residing in the Pacific or Mountain time zones are preferred.

About Comagine Health

Comagine Health is a national, nonprofit healthcare consulting firm. We collaborate with patients, providers, payers, and other stakeholders to reimagine, redesign, and implement sustainable improvements in the healthcare system. We work in our communities to address complex health and healthcare delivery problems, drawing upon our expertise in quality improvement, care management, health information technology, analytics, and research.

Key Responsibilities

1. Participate in a multidisciplinary team to improve healthcare quality for individuals and populations.
2. Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.
3. Consult with physicians or refer cases to others when indicated.

Competencies

• Intermediate proficiency in MS Office Suite.
• Natural curiosity and desire to learn with attention to detail.
• Ability to work independently with minimal supervision in a quality or productivity-driven environment, as well as collaboratively in a team.

Required Qualifications

• Degree or diploma in nursing; an equivalent combination of education and/or work experience may be substituted.
• Current, active, unrestricted RN license in Washington state.
• At least 5 years of clinical (direct patient care) experience, including ICU and/or ER experience.
• At least 1 year of utilization review or similar medical management experience.
• Reside in the Pacific or Mountain time zones preferred.

For full details, follow the application link. Comagine Health is an Equal Employment Opportunity/Affirmative Action Employer that values diversity and encourages minorities, protected veterans, and individuals with disabilities to apply.

Application link: ipc.us/t/AAE0AC47C609493B