Clinical Reviewer – Lead

Comagine Health

Lead Clinical Reviewer for Comagine Health managing clinical review teams to ensure compliance and quality in healthcare services. Analyzing data and improving processes within the DC Medicaid Contract.

Posted 4/16/2026full-timeRemote • District of Columbia • 🇺🇸 United StatesSenior💰 $90,000 - $119,000 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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!

ATS Keywords

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Applicant Tracking System Keywords

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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)