Clinical Reviewer

Comagine Health

Clinical Reviewer at Comagine Health focusing on healthcare service necessity assessment. Analyzing compliance with organizational policies and interacting with various healthcare stakeholders.

Posted 4/16/2026full-timeRemote • Washington • 🇺🇸 United StatesMid-LevelSenior💰 $40 - $50 per hourWebsite

About the role

Key responsibilities & impact

Conduct prospective, concurrent, and retrospective utilization management reviews
Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual)
Consult with physician/practitioner consultants when services do not meet medical necessity criteria
Collaborate with internal teams and refer cases for additional review or escalation as appropriate
Respond to provider, customer, and stakeholder questions regarding determinations and processes

Requirements

What you’ll need

BA/BS in Nursing
Minimum of 3 years of direct patient care (clinical) experience
Current, active, unrestricted RN license Washington D.C.
Experience with InterQual Criteria
Strong proficiency in Microsoft Office Suite and familiarity with database systems

Benefits

Comp & perks

Annual stipend for enhancing workspace
Support and embrace remote work
Opportunities to make a difference from anywhere in the U.S. with better work-life balance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization managementclinical review criteriaInterQualdirect patient caredatabase systems

Soft Skills

collaborationconsultationcommunication

Certifications

RN licenseBA/BS in Nursing