Remote Clinical Reviewer RN — Healthcare Quality

Comagine Health; Jackson (MS); Remote; USD 90.000 - 110.000; Vollzeit

Benefits dieser Stelle

Remote work opportunity in WA

Medical, dental, vision insurance

401(k) with company match

Paid time off and holidays

Home office stipend

Professional development opportunities

Collaborative work environment

Meaningful impact on healthcarequality

Zusammenfassung

Comagine Health is seeking a licensed RN for a remote Clinical Reviewer role supporting the Washington L&I contract. The position focuses on evaluating medical necessity, clinical appropriateness, and quality of healthcare services through prospective, concurrent, and retrospective reviews.

You'll collaborate with physician consultants and internal teams, apply evidence-based criteria, and document reviews to ensure compliance with contractual and regulatory standards.

Qualifikationen

• Active, unrestricted RN license in Washington state.
• Minimum of five years of direct patient care nursing experience.
• Ability to interpret and apply clinical guidelines and criteria.
• Experience applying clinical judgment to evaluate patient care and medical documentation.

Aufgaben

• Conduct prospective, concurrent, and retrospective clinical reviews for inpatient and outpatient services.
• Evaluate requests to determine meeting clinical criteria and appropriateness of care.
• Apply established criteria, policies, regulatory requirements, and evidence-based guidelines.
• Collaborate with physician consultants and internal teams to ensure accurate reviews.
• Document reviews in accordance with procedures and contractual expectations.
• Provide QA and operational support to ensure contract requirements.

Kenntnisse

Clinical assessment

Critical thinking

Written communication

Verbal communication

Organizational skills

Independent work

EMR proficiency

Ausbildung

Bachelor's degree (BA/BS)

Tools

EMR systems

Jobbeschreibung

Comagine Health is seeking a licensed RN for a remote Clinical Reviewer role supporting the Washington L&I contract. The position focuses on evaluating medical necessity, clinical appropriateness, and quality of healthcare services through prospective, concurrent, and retrospective reviews.

You'll collaborate with physician consultants and internal teams, apply evidence-based criteria, and document reviews to ensure compliance with contractual and regulatory standards.