Clinical Reviewer
Comagine Health
full-time
Posted on:
Location Type: Remote
Location: Washington • United States
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Salary
💰 $40 - $50 per hour
About the role
- 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
- 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
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementclinical review criteriaInterQualdirect patient caredatabase systems
Soft Skills
collaborationconsultationcommunication
Certifications
RN licenseBA/BS in Nursing