Clinical Reviewer WA L&I

Comagine Health; Milwaukee (WI); Remote; USD 83,000 - 115,000; Full time

Job summary

An innovative health care consulting firm is seeking a remote Clinical Reviewer RN to enhance the quality of care for individuals and populations. In this pivotal role, you'll apply nationally-recognized clinical criteria to assess medical necessity, collaborate with a multi-disciplinary team, and contribute to sustainable improvements in the health care system. This position offers the chance to work independently while being part of a dedicated team focused on quality improvement and patient care. If you are passionate about making a difference in health care delivery, this opportunity is perfect for you.

Qualifications

• 5 years of clinical experience or ICU/ER experience.
• Current RN license in Washington state required.

Responsibilities

• Participate in a multi-disciplinary team to improve healthcare quality.
• Apply clinical criteria to determine medical necessity.

Skills

Clinical Review

Utilization Review

MS Office Suite

Attention to Detail

Independent Work

Education

Degree or Diploma in Nursing

Job description

Clinical Reviewer WA L&I

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Category

Care Management

Job Location

Remote

Tracking Code

134769

Industry

Health Care

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 assure 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.

Because of our contractual requirements for RN reviewer coverage until at least 5:00 pm Pacific Time, Nurses who reside in the Pacific or Mountain time zones are preferred.

Who is Comagine Health?

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.

We invite our partners and communities to work with us to improve health and redesign the health care delivery system.

Some of what you'll be doing:

• Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.


• Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.


• Consult with physicians or refer cases to others, when indicated.

Competencies:

• Intermediate MS Office Suite proficiency.


• Have a natural curiosity and desire to learn with attention to detail.


• Ability to work independently with minimal supervision in a quality or productivity-driven and team-oriented environment.

Required Qualifications:

• Degree or diploma in nursing (an equivalent combination of education and/or work experience in a related field may be substituted.)


• Current, active, unrestricted RN license in Washington state.


• 5 years of clinical (direct patient care) experience or ICU and/or ER experience.


• 1 year of utilization review (or other medical management experience.)

Nurses who reside in the Pacific or Mountain time zones are preferred.

Salary Range: $83,000 - $115,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.