Remote RN Clinical Reviewer — Elevate Healthcare Quality

Lonestar State College; Anchorage (AK); Remote; USD 95,000 - 115,000; Full time

Benefits offered by this job

Remote work WA

Insurance

401(k)

PTO & holidays

Home office stipend

Professional development

Collaborative environment

Meaningful impact

Job summary

Comagine Health is seeking a Clinical Reviewer (RN) remotely to support Washington state contracts. The role evaluates medical necessity and quality of care, collaborating with physician consultants and internal teams to ensure compliant, evidence-based decisions.

The ideal candidate has 5+ years of direct patient care experience, a WA RN license, and strong clinical judgment. Remote work, competitive benefits, and professional development opportunities are offered.

Qualifications

• Current, active, unrestricted RN license in WA.
• Minimum of five (5) years of direct patient care nursing experience.
• Ability to interpret and apply clinical guidelines and criteria.
• Excellent written and verbal communication; strong attention to detail.

Responsibilities

• Perform prospective, concurrent, and retrospective clinical reviews for inpatient and outpatient services.
• Evaluate requests against established clinical criteria to determine medical necessity and appropriateness.
• Apply review criteria, policies, and evidence-based guidelines; review medical records for accuracy.
• Collaborate with physician consultants and internal teams to ensure timely, accurate determinations.

Skills

RN license

Clinical nursing

Clinical judgment

Written and verbal communication

Independent work

Documentation and record review

Education

Bachelor's degree (BA/BS)

Tools

Electronic Medical Records (EMR)

Job description

Comagine Health is seeking a Clinical Reviewer (RN) remotely to support Washington state contracts. The role evaluates medical necessity and quality of care, collaborating with physician consultants and internal teams to ensure compliant, evidence-based decisions.

The ideal candidate has 5+ years of direct patient care experience, a WA RN license, and strong clinical judgment. Remote work, competitive benefits, and professional development opportunities are offered.