Clinical Reviewer

Comagine Health

Clinical Reviewer in a nonprofit improving healthcare quality through utilization management reviews. Remote, full-time role for RN with patient care experience in New Mexico.

Posted 6/18/2026full-timeRemote • New Mexico • 🇺🇸 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 utilization management reviews
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
Refer cases to management when required
Provide clinical and utilization review subject matter expertise
Respond to provider, customer, and stakeholder questions regarding determinations and processes
Conduct outreach to providers, case managers, consultants, and community support coordinators to obtain additional clinical information
Maintain accurate documentation and comply with all regulatory and contract standards

Requirements

What you’ll need

BA/BS in Nursing
Equivalent combination of education and/or related experience may be considered depending on contract
Minimum of 3 years of direct patient care (clinical) experience
Current, active, unrestricted RN license
Must meet New Mexico state and contract-specific requirements
Experience with InterQual Criteria
Strong proficiency in Microsoft Office Suite and familiarity with database systems.

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

utilization managementclinical review criteriaInterQualdocumentationpatient careclinical expertiseregulatory compliancescreening toolscase managementoutreach

Soft Skills

collaborationconsultationcommunicationproblem-solvingstakeholder engagementorganizational skillsattention to detailcustomer serviceteamworkadaptability

Certifications

RN licenseBA/BS in Nursing