Clinical Reviewer

🔥 18 minutes ago

🇺🇸 United States – Remote

💵 $35 - $48 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

👻 Ghost score 2%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 70 days.

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Comagine Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1973

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

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

• Evaluate authorization requests and supporting medical records for medical necessity and appropriateness • Apply workers’ compensation treatment guidelines, clinical criteria, organizational policies, InterQual criteria, screening tools, and contract requirements specific to Alaska • Approve appropriate cases or refer cases requiring additional review to Medical Affairs, physician reviewers, management, or consultants • Conduct prospective, concurrent, and retrospective utilization management reviews • Research applicable treatment guidelines and document decisions and supporting rationale • Manage pended cases and obtain additional information through providers or the claim system • Communicate with clinics and respond to provider, customer, and stakeholder questions • Consult with physician/practitioner consultants when services do not meet medical necessity criteria • Conduct outreach to providers, case managers, consultants, and community support coordinators • Maintain accurate documentation and comply with regulatory and contract standards • Collaborate with physician advisors, providers, and internal teams to support accurate, timely, and well-documented review decisions • Provide clinical and utilization review subject matter expertise

🎯 Requirements

• Availability for at least two four-hour shifts per week • Minimum of 3 years of direct patient care (clinical) experience • Current, active, unrestricted RN license and/or LCSW, LMHC, LCP • Experience with InterQual Criteria • Strong proficiency in Microsoft Office Suite • Familiarity with database systems • Excellent written and verbal communication skills • Strong organizational, analytical, and problem-solving abilities • Ability to manage multiple priorities in a fully remote, team-based environment • Reliable, secure internet connection • Must maintain licensure eligibility for assigned state contract • Must be able to sit for extended periods and communicate effectively • Valid driver's license and driving eligibility requirements where business vehicle operation is required

🏖️ Benefits

• 100% remote work • Annual workspace enhancement stipend • Work-life balance support • Occasional travel for meetings, training, or other work-related events • Reasonable accommodations for individuals with disabilities

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