Remote RN: Clinical Utilization Reviewer (Alabama)

COMAGINE HEALTH; Washington (Washington County); On-site; USD 75,000 - 95,000; Full time

Job summary

Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama for remote assessment of medical necessity and quality of care across prospective, concurrent, and retrospective reviews. This full-time role supports compliant, cost-effective care in line with Alabama contracts.

You will apply Alabama Medicaid criteria, meet timelines, and collaborate with a Physician Advisor to review complex cases while coordinating with administrative teams.

Qualifications

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

Responsibilities

• Apply Alabama Medicaid criteria to determine medical necessity.
• Complete reviews within state and federal timelines.
• Consult with Physician Advisor for complex cases.
• Coordinate with administrative support as appropriate.
• Identify customer needs and respond promptly.

Skills

RN

Alabama license

Clinical review

Provider relations

Reporting

Education

BA/BS in Nursing

Job description

Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama for remote assessment of medical necessity and quality of care across prospective, concurrent, and retrospective reviews. This full-time role supports compliant, cost-effective care in line with Alabama contracts.

You will apply Alabama Medicaid criteria, meet timelines, and collaborate with a Physician Advisor to review complex cases while coordinating with administrative teams.