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Clinical Reviewer, RN
Comagine HealthClinical Reviewer RN assessing healthcare services' medical necessity in Alabama for a nonprofit healthcare organization. Supporting high-quality, cost-effective care with compliance to clinical criteria and policies.
Posted 4/15/2026full-timeRemote • Alabama • 🇺🇸 United StatesMid-LevelSenior💰 $75,000 - $88,000 per yearWebsite
About the role
Key responsibilities & impact- Assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews
- Apply Alabama Medicaid program criteria and guidelines to determine medical necessity
- Complete reviews within timelines established by all applicable state and federal requirements
- Consult and forward cases for which a medical necessity determination cannot be rendered
- Identify customer needs and expectations and respond to them in a timely and effective manner
- Attend Medicaid meetings, fair hearings, and legislative committee meetings as required
Requirements
What you’ll need- BA/BS in Nursing
- Active RN in Alabama
- Minimum of 3 years of direct patient care (clinical) experience
- Current, active, unrestricted RN license in Alabama
- Experience with performing PA reviews
- Experience in long-term care including nursing homes, ICF/IID, swing beds, PEC, and inpatient psychiatric facilities
- Must maintain licensure eligibility for assigned state contract
Benefits
Comp & perks- Annual stipend for workspace enhancement
- Remote work options
- Opportunities to make a difference from anywhere in the U.S.
- Better work-life balance
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementmedical necessity determinationPA reviewsclinical experiencelong-term carenursing homesICF/IIDswing bedsinpatient psychiatric facilities
Soft Skills
customer needs assessmenttimely responseeffective communication
Certifications
BA/BS in Nursingactive RN license in Alabama