Remote RN: Clinical Utilization Review (Alabama)

COMAGINE HEALTH; Washington (District of Columbia); Remote; USD 70,000 - 90,000; Full time

Job summary

Comagine Health is seeking Clinical Utilization Review Nurses (RN) licensed in Alabama for a remote, full-time role. You will assess medical necessity and quality of healthcare services through prospective, concurrent, and retrospective reviews to support compliant, cost-effective care.

Experience in Medicaid criteria, long-term care settings, and provider relations will help you succeed. A valid Alabama RN license and 3+ years of clinical practice are required.

Qualifications

• BA/BS in Nursing required.
• Active RN license in Alabama required.
• Minimum of 3 years direct patient care experience.

Responsibilities

• Apply Alabama Medicaid criteria to determine medical necessity.
• Complete reviews within timelines per state/federal requirements.
• Consult with Physician Advisor on difficult cases.
• Work with administrative support as appropriate.
• Identify customer needs and respond promptly.
• Anticipate delays and keep customers informed.
• Attend Medicaid meetings and related government meetings when requested.

Skills

PA reviews

Long-term care

ICF/IID

Swing bed

Inpatient psychiatric

Provider relations

Reporting

Education

BSN or higher in Nursing

RN license Alabama

Job description

Comagine Health is seeking Clinical Utilization Review Nurses (RN) licensed in Alabama for a remote, full-time role. You will assess medical necessity and quality of healthcare services through prospective, concurrent, and retrospective reviews to support compliant, cost-effective care.

Experience in Medicaid criteria, long-term care settings, and provider relations will help you succeed. A valid Alabama RN license and 3+ years of clinical practice are required.