Clinical Reviewer

Comagine Health is looking for a remote RN Clinical Reviewer to support our growing team. This role will support a variety of patient populations across the organization, providing utilization management and care planning as needed.

Who is Comagine Health?

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.

We invite our partners and communities to work with us to improve health and redesign the health care delivery system.

Some of what you'll be doing for us:

• Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.
• Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.
• Consult with physicians or refer cases to others, when indicated.

Competencies:

• Professional curiosity and lifelong learner mindset--we cover many contracts with this team and there is always something new!
• Excellent written and oral communication
• Ability to document critical thinking and develop questions for providers regarding decision-making and plan of care
• Strong MS Office Suite proficiency and familiarity with database software programs
• Strong organizational skills
• Excellent interpersonal and problem-solving skills
• Ability to organize and coordinate multiple simultaneous tasks in a team environment

Required Qualifications:

• A degree or diploma in nursing.
• Current, active, unrestricted RN licensure in good standing.
• 3 years of clinical (direct patient care) work experience that includes critical care, ED, and/or intensive care.

Desired Qualifications

• 1+ years of utilization review (or other medical management experience)