Clinical Reviewer

Why Comagine Health? Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs. We believe in an environment that allows you to thrive both personally and professionally. That’s why we offer benefits that include: 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! Position Overview

We are seeking a

Clinical Utilization Review Nurse (RN)

to assess the

medical necessity and quality of healthcare services

through prospective, concurrent, and retrospective utilization management reviews. This

full-time, remote position

supports high-quality, appropriate, and cost-effective care while ensuring compliance with clinical criteria, organizational policies, and contract requirements specific to Alaska. Key Responsibilities

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

Education & Experience

BA/BS in Nursing An equivalent combination of education and/or related experience may be considered depending on contract

Minimum of 3 years of direct patient care (clinical) experience

Licensure

Current, active, unrestricted RN license Must meet Alaska

state and contract-specific requirements

Required Skills & Competencies

Experience with

InterQual Criteria

Strong proficiency in

Microsoft Office Suite

and 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

Work Environment

Full-Time

100% Remote (United States)

Reliable, secure internet connection required

Must maintain licensure eligibility for assigned state contract

Equal Opportunity Employer Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace. Physical Requirements & Work Environment This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively. Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver’s license and meet the organization’s driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events. Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.