[Hiring] Clinical Reviewer @Comagine Health

Role Description

The PRN/part-time position requires availability for at least two four-hour shifts per week. The hours are not limited. Weekend hours are available.

Clinical Reviewers work from an electronic review queue to evaluate applicable authorization requests and supporting medical records for medical necessity and appropriateness. They apply workers’ compensation treatment guidelines, clinical criteria, and organizational policies to approve cases when appropriate or refer cases requiring additional review to Medical Affairs and physician reviewers. Reviewers research applicable treatment guidelines, document decisions and supporting rationale. They also manage pended cases, obtain additional information through providers or the claim system, and communicate with clinics. Clinical Reviewers collaborate with physician advisors, providers, and internal teams to support accurate, timely, and well-documented review decisions.

If you’re ready to put your clinical expertise and critical thinking skills to work in a role focused on thoughtful, evidence-based review, we encourage you to apply and learn more about joining our team.

Qualifications

• Minimum of 3 years of direct patient care (clinical) experience
• Current, active, unrestricted RN license and/or LCSW, LMHC, LCP

Requirements

• Experience with InterQual Criteria
• Strong proficiency in Microsoft Office Suite and familiarity with database systems
• Excellent written and verbal communication skills
• Strong organizational, analytical, and problem-solving abilities
• Ability to manage multiple priorities in a fully remote, team-based environment

Benefits

• Annual stipend to enhance your workspace
• Support for remote work and work-life balance

Company Description

Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.

• Leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.
• Talented remote workforce spans the country and plays a vital role in our success.
• We believe in an environment that allows you to thrive both personally and professionally.