Remote RN - Clinical Utilization Reviewer (Alabama)

Palo Verde Community College District; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Annual workspace stipend

Job summary

Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective care within contract guidelines.

Applicants must be an active RN in Alabama with at least 3 years of direct patient care experience and a BA/BS in Nursing. Experience in long-term care, provider relations, and PA reviews is valued.

Qualifications

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

Responsibilities

• Apply Alabama Medicaid program criteria to determine medical necessity.
• Complete reviews within state/federal timelines.
• Consult with Physician Advisor on complex cases.
• Maintain licensure eligibility and comply with contracts.

Skills

PA reviews

Long-term care

Provider relations

Reporting

Education

BA/BS in Nursing

Job description

Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective care within contract guidelines.

Applicants must be an active RN in Alabama with at least 3 years of direct patient care experience and a BA/BS in Nursing. Experience in long-term care, provider relations, and PA reviews is valued.