Remote RN — Clinical Utilization Review Specialist (Alabama)

Comagine; Northern (KY); Hybrid; USD 75,000 - 88,000; Full time

Benefits offered by this job

Remote work nationwide

Job summary

Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts.

You will apply Alabama Medicaid criteria, complete reviews within required timelines, consult with a Physician Advisor when needed, work with administrative staff, and maintain an active Alabama RN license and reliable internet access.

Qualifications

• BA/BS in Nursing required.
• Active RN license in Alabama.
• Minimum of 3 years of direct patient care (clinical) experience.
• Current, active, unrestricted RN license in Alabama.

Responsibilities

• Apply Alabama Medicaid program criteria to determine medical necessity.
• Complete reviews within timelines established by state and federal requirements.
• Consult with Physician Advisor/ Consulting Physician for cases needing medical judgment.
• Coordinate with administrative support as appropriate.
• Identify customer needs and respond in a timely and effective manner.
• Anticipate and prevent delays or adverse impacts to customers and keep them informed.
• Attend Medicaid meetings and hearings as requested.

Skills

Clinical nursing

RN license

Education

BA/BS in Nursing

Job description

Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts.

You will apply Alabama Medicaid criteria, complete reviews within required timelines, consult with a Physician Advisor when needed, work with administrative staff, and maintain an active Alabama RN license and reliable internet access.