Comagine Health
201 - 500 employees
Founded 1973
🤝 Non-profit
🤝 B2B
🔬 Science
Non-profit • B2B • Science
Comagine Health is a national nonprofit health care consulting organization that partners with providers, payers, public agencies, community organizations and consumers to improve health care quality, equity, and outcomes. It offers systemwide quality improvement, care management, data solutions, research and evaluation, and COVID-19 response services, using health information exchange and health IT to inform public health surveillance and program design. Comagine focuses on supporting community health, behavioral health, and patient-centered initiatives through technical assistance, evaluation, and collaborative systems-level work.
Clinical Reviewer, RN
🕒 April 15
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
Comagine Health
201 - 500 employees
Founded 1973
🤝 Non-profit
🤝 B2B
🔬 Science
Non-profit • B2B • Science
Comagine Health is a national nonprofit health care consulting organization that partners with providers, payers, public agencies, community organizations and consumers to improve health care quality, equity, and outcomes. It offers systemwide quality improvement, care management, data solutions, research and evaluation, and COVID-19 response services, using health information exchange and health IT to inform public health surveillance and program design. Comagine focuses on supporting community health, behavioral health, and patient-centered initiatives through technical assistance, evaluation, and collaborative systems-level work.
📋 Description
• Assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews • Apply Alabama Medicaid program criteria and guidelines to determine medical necessity • Complete reviews within timelines established by all applicable state and federal requirements • Consult and forward cases for which a medical necessity determination cannot be rendered • Identify customer needs and expectations and respond to them in a timely and effective manner • Attend Medicaid meetings, fair hearings, and legislative committee meetings as required
🎯 Requirements
• BA/BS in Nursing • Active RN in Alabama • Minimum of 3 years of direct patient care (clinical) experience • Current, active, unrestricted RN license in Alabama • Experience with performing PA reviews • Experience in long-term care including nursing homes, ICF/IID, swing beds, PEC, and inpatient psychiatric facilities • Must maintain licensure eligibility for assigned state contract
🏖️ Benefits
• Annual stipend for workspace enhancement • Remote work options • Opportunities to make a difference from anywhere in the U.S. • Better work-life balance
Apply NowSimilar Jobs
🕒 October 10, 2025
Freelance medical reviewer improving content accuracy for MyHealthTeam. Assessing medical information and ensuring its clarity for laypeople while working remotely.
