Remote Clinical Utilization Review Nurse (AL)

Anacalifornia; Sacramento (CA); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Remote work option

Annual workspace stipend

Job summary

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a remote, full-time role based primarily in Alabama. You will assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews, ensuring compliance with clinical criteria, policies, and Alabama contract requirements.

Qualified candidates hold a BA/BS in Nursing, current Alabama RN licensure, and at least three years of direct patient care experience.

Qualifications

• BA/BS in Nursing is required.
• Active RN license in Alabama.
• Minimum 3 years of direct patient care (clinical) experience.

Responsibilities

• Apply Alabama Medicaid program criteria to determine medical necessity.
• Complete reviews within state and federal timelines.
• Consult with Physician Advisor for cases needing medical justification.
• Collaborate with administrative support as needed.
• Identify customer needs and respond promptly to inquiries.
• Anticipate delays and keep customers informed of status.

Education

BA/BS in Nursing

Active RN license

3+ years direct patient care

Job description

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a remote, full-time role based primarily in Alabama. You will assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews, ensuring compliance with clinical criteria, policies, and Alabama contract requirements.

Qualified candidates hold a BA/BS in Nursing, current Alabama RN licensure, and at least three years of direct patient care experience.