Remote Clinical Utilization Review RN

Comagine-Health; Alaska; Hybrid; USD 79,000 - 104,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off

Retirement savings plan with employer

Paid parental leave

Job summary

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This is a full-time, remote role supporting Alaska contracts.

The position requires a BA/BS in Nursing, 3 years of direct patient care, and an active RN license, with proficiency in InterQual criteria and MS Office. Telework is supported nationwide with comprehensive benefits.

Qualifications

• BA/BS in Nursing or equivalent.
• Minimum 3 years of direct patient care (clinical) experience.
• Current, active, unrestricted RN license.
• Experience with InterQual Criteria.
• Strong written and verbal communication skills.

Responsibilities

• Conduct prospective, concurrent, and retrospective utilization management reviews.
• Apply clinical review criteria and organizational policies.
• Consult with physician/practitioner consultants when services do not meet medical necessity.
• Collaborate with internal teams and refer cases for escalation.
• Maintain accurate documentation and comply with regulatory standards.

Skills

InterQual Criteria

Microsoft Office Suite

Data base systems

Clinical review

Effective communication

Organizational skills

Education

BA/BS in Nursing

Tools

InterQual

Microsoft Office

Database systems

Job description

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This is a full-time, remote role supporting Alaska contracts.

The position requires a BA/BS in Nursing, 3 years of direct patient care, and an active RN license, with proficiency in InterQual criteria and MS Office. Telework is supported nationwide with comprehensive benefits.