Remote RN Clinical Reviewer: Elevate Healthcare Quality

California Nursing Students Association Incorporated; Washington; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work opportunities

Medical, dental, vision insurance

401(k) with company match

Paid time off and holidays

Home office stipend

Job summary

Comagine Health, a national nonprofit healthcare consulting organization, seeks a Clinical Reviewer (RN) to support the Washington Labor & Industries contract. This remote role leverages nursing expertise to evaluate medical necessity and quality of care, collaborating with physicians and internal teams.

You will conduct prospective, concurrent, and retrospective reviews, ensure documentation supports decisions, and contribute to ongoing quality improvement in a home-based setting.

Qualifications

• Active RN license in Washington state.
• Minimum 5 years of clinical nursing experience in direct patient care.
• Ability to interpret clinical guidelines and medical necessity criteria.

Responsibilities

• Perform prospective (pre-authorization), concurrent (continued stay), and retrospective clinical reviews for services.
• Consult with physician/practitioner reviewers and internal teams to ensure accurate determinations.
• Support compliance with contract requirements and quality improvement initiatives.

Skills

RN license

Clinical judgment

Documentation review

EMR proficiency

Education

Bachelor's degree

Tools

EMR systems

Job description

Comagine Health, a national nonprofit healthcare consulting organization, seeks a Clinical Reviewer (RN) to support the Washington Labor & Industries contract. This remote role leverages nursing expertise to evaluate medical necessity and quality of care, collaborating with physicians and internal teams.

You will conduct prospective, concurrent, and retrospective reviews, ensure documentation supports decisions, and contribute to ongoing quality improvement in a home-based setting.