Remote RN: Clinical Utilization Review

COMAGINE HEALTH; Las Vegas (NV); On-site; USD 90,000 - 120,000; Full time

Job summary

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria and organizational policies.

Required BA/BS in Nursing with a current RN license and at least 3 years of direct patient care. Strong communication, organizational, and analytical skills are essential for success in a fully

Qualifications

• BA/BS in Nursing or equivalent combination of education and related experience.
• Minimum of 3 years of direct patient care (clinical) experience.
• Current, active, unrestricted RN license; Alaska state requirements apply.

Responsibilities

• Conduct prospective, concurrent, and retrospective utilization management reviews.
• Apply InterQual criteria and organizational policies.
• Consult with physician/practitioner consultants when services do not meet medical necessity.
• Collaborate with internal teams and refer cases for additional review or escalation.
• Refer cases to management when required.
• Provide clinical and utilization review subject matter expertise.
• Respond to provider, customer, and stakeholder questions regarding determinations and processes.
• Outreach to providers and care coordinators to obtain additional clinical information.
• Maintain accurate documentation and comply with regulatory and contract standards.

Skills

InterQual Criteria

Microsoft Office

Written & verbal communication

Organizational skills

Analytical skills

Remote work capability

Education

BA/BS in Nursing or equivalent

3+ years direct patient care

Tools

Database systems

Job description

Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria and organizational policies.

Required BA/BS in Nursing with a current RN license and at least 3 years of direct patient care. Strong communication, organizational, and analytical skills are essential for success in a fully