Clinical Reviewer WA L&I

Comagine Health; United States; Remote; USD 83,000 - 115,000; Full time

Job summary

Join a forward-thinking nonprofit health care consulting firm as a remote Clinical Review RN. In this pivotal role, you will collaborate with a multi-disciplinary team to enhance the quality of healthcare for individuals and populations. Your expertise will guide clinical assessments, ensuring that patients receive necessary care while avoiding overuse or misuse of services. This position offers a unique opportunity to make a significant impact on healthcare delivery through data-driven reviews and consultations. If you are passionate about improving health outcomes and thrive in a collaborative environment, this role is for you.

Qualifications

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

Responsibilities

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

Skills

Clinical Review

Attention to Detail

Independent Work

Communication

Education

Degree or diploma in nursing

Tools

MS Office Suite

Job description

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:

1. Participate in a multi-disciplinary team to improve the quality of healthcare 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:

1. Intermediate MS Office Suite proficiency.
2. Have a natural curiosity and desire to learn with attention to detail.
3. Ability to work independently with minimal supervision in a quality or productivity-driven and team-oriented environment.

Required Qualifications:

1. Degree or diploma in nursing (an equivalent combination of education and/or work experience in a related field may be substituted.)
2. Current, active, unrestricted RN license in Washington state.
3. 5 years of clinical (direct patient care) experience or ICU and/or ER experience.
4. 1 year of utilization review (or other medical management experience.)

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.