Remote RN Utilization Reviewer — Alabama

Anacalifornia; Sacramento, Northern (CA, KY); Hybrid; USD 80,000 - 105,000; Full time

Benefits offered by this job

Remote work

Workspace stipend

Job summary

Comagine Health is seeking Clinical Utilization Review Nurses (RN) for a remote, full-time role. Licensed RNs in Alabama will assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization management reviews.

The position requires a BA/BS in Nursing, current Alabama RN licensure, and a minimum of 3 years direct clinical experience. You will apply Alabama Medicaid criteria, work with physicians as needed, and ensure compliance with contracts and policy

Qualifications

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

Responsibilities

• Apply Alabama Medicaid criteria to determine medical necessity.
• Complete reviews within state and federal timelines.
• Refer complex cases to Physician Advisor.
• Coordinate with administrative support.
• Identify and respond to customer needs promptly.
• Inform customers about delays and status of actions.
• Attend Medicaid meetings and related government meetings as needed.

Skills

Clinical utilization review

Alabama Medicaid criteria

Nursing clinical experience

Collaboration with physicians

Education

BA/BS in Nursing

Job description

Comagine Health is seeking Clinical Utilization Review Nurses (RN) for a remote, full-time role. Licensed RNs in Alabama will assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization management reviews.

The position requires a BA/BS in Nursing, current Alabama RN licensure, and a minimum of 3 years direct clinical experience. You will apply Alabama Medicaid criteria, work with physicians as needed, and ensure compliance with contracts and policy