Clinical Reviewer – Lead
Comagine Health
full-time
Posted on:
Location Type: Remote
Location: District of Columbia • United States
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Salary
💰 $90,000 - $119,000 per year
Job Level
About the role
- Lead and mentor a team of clinical reviewers, providing training, performance feedback, and professional development opportunities.
- Conduct and oversee detailed clinical reviews of medical records, claims, and related documentation to ensure accuracy and compliance with established guidelines.
- Collaborate with healthcare providers, auditors, and internal departments to resolve discrepancies and improve review processes.
- Develop, update, and implement clinical review protocols and quality assurance measures to maintain regulatory compliance and enhance review effectiveness.
- Analyze clinical data and review outcomes to identify trends, recommend improvements, and support strategic decision-making.
Requirements
- Bachelor’s degree in Nursing, Health Sciences, or a related clinical field.
- Active RN licensure.
- Minimum of 5 years of clinical review experience within healthcare services.
- Strong knowledge of medical terminology, clinical documentation, and healthcare regulations.
- Proven leadership experience managing clinical teams or projects.
- Excellent analytical, communication, and organizational skills.
- Master’s degree in Nursing, Healthcare Administration, or a related discipline (preferred).
- Certification in Clinical Documentation Improvement (CDI) or Certified Professional Medical Auditor (CPMA) (preferred).
- Experience with electronic health record (EHR) systems and clinical review software (preferred).
- Familiarity with Medicare, Medicaid, and other payer regulations (preferred).
- Experience working in a fast-paced healthcare environment with multidisciplinary teams (preferred).
Benefits
- Medical, dental and vision insurance
- Paid time off for vacation, illness and volunteering
- Retirement savings plan with employer contribution
- Adoption financial assistance
- Paid parental leave
- And much more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewmedical record analysisclaims reviewclinical documentationregulatory compliancedata analysisquality assurancehealthcare regulationsmedical terminologyclinical review protocols
Soft Skills
leadershipmentoringcommunicationorganizational skillsanalytical skills
Certifications
RN licensureCertification in Clinical Documentation Improvement (CDI)Certified Professional Medical Auditor (CPMA)