Remote RN Clinical Reviewer - Healthcare Quality

Comagine-Health; Washington; Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Remote work WA

Health insurance

401(k) match

PTO & holidays

Home office stipend

Professional development

Job summary

Comagine Health in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and retrospective reviews for inpatient and outpatient services.

You will work with physician consultants, adhere to contract and regulatory standards, and support continuous quality improvement while enjoying the flexibility of a remote, work-from-home

Qualifications

• Licensed, active RN in Washington
• Minimum 5 years of direct patient care nursing experience
• Ability to interpret clinical guidelines and medical necessity criteria
• Strong communication and collaboration with physicians and teams
• Proficient in clinical documentation and reviews

Responsibilities

• Conduct prospective, concurrent, and retrospective clinical reviews for inpatient/outpatient services.
• Evaluate requests against criteria and guidelines to determine medical necessity.
• Collaborate with physician consultants and internal teams to ensure accurate reviews.
• Ensure documentation meets contractual and regulatory requirements.
• Support quality assurance and continuous improvement in review processes.

Skills

Clinical assessment

Critical thinking

Written communication

Verbal communication

Independent work

Education

Bachelor's degree (BA/BS)

Tools

EMR systems

Job description

Comagine Health in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and retrospective reviews for inpatient and outpatient services.

You will work with physician consultants, adhere to contract and regulatory standards, and support continuous quality improvement while enjoying the flexibility of a remote, work-from-home