Remote RN: Clinical Utilization Review Expert

COMAGINE HEALTH; Murray (UT); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off for vacation and illness

Retirement savings plan with employer

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health, a national nonprofit, is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote role in the United States. The candidate will assess medical necessity and quality across prospective, concurrent, and retrospective reviews, ensuring compliance with criteria and contract requirements.

Alaska-specific contract requirements may apply. The position requires a BA/BS in Nursing, an active RN license, and at least 3 years of direct patient care.

Qualifications

• BA/BS in Nursing or equivalent combination of education/experience
• Minimum of 3 years of direct patient care (clinical) experience
• RN license active and unrestricted; Alaska requirements may apply per contract

Responsibilities

• Conduct prospective, concurrent, and retrospective utilization management reviews
• Apply InterQual criteria and organizational policies
• Consult with physician/practitioner when services do not meet medical necessity
• Collaborate with internal teams and escalate cases as needed
• Refer cases to management when required
• Provide clinical and utilization review SME support
• Respond to provider, customer, and stakeholder questions
• Outreach to providers and case managers for information
• Maintain documentation meeting regulatory and contract standards

Skills

InterQual Criteria

Communication

Organizational/Analytical

Multitasking in remote team

Education

BA/BS in Nursing

Tools

Microsoft Office

Database systems

Job description

Comagine Health, a national nonprofit, is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote role in the United States. The candidate will assess medical necessity and quality across prospective, concurrent, and retrospective reviews, ensuring compliance with criteria and contract requirements.

Alaska-specific contract requirements may apply. The position requires a BA/BS in Nursing, an active RN license, and at least 3 years of direct patient care.