Comagine Health is looking for a remote Clinical Reviewer based in Eastern Time Zone. You will assess the medical necessity and quality of healthcare services by conducting prospective, concurrent, and retrospective utilization management reviews. Working closely with Intake Representatives, you will work primarily with the Elderly Persons Disability (EPD) waiver program, vetting documents provided by the entities in DC and approving services for appropriateness. If this sounds like a role you’d be interested in, we encourage you to read on and apply!

Who is Comagine Health?

Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.

What you’ll be doing for us:

• Apply clinical review criteria, organizational policies, guidelines, and screens to determine the medical necessity of health care services.
• Consult with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens.
• Refer cases to other clinicians, when indicated.
• As appropriate, provide daily oversight and monitoring of non-clinical staff during their performance of non-clinical support activities; also provide the supervisor with input regarding employees’ performance of these activities.
• May perform quality assurance audits and other program support, as assigned by supervisor.
• Other duties as assigned.

Competencies:

• Strong MS Office Suite proficiency and familiarity with database software programs.
• Strong organizational skills.
• Excellent oral and written communications skills.
• Excellent interpersonal and problem-solving skills.
• Ability to organize and coordinate multiple simultaneous tasks in a team environment.

Required Qualifications:

• Current, active, unrestricted RN licensure in DC.
• 3 years of clinical (direct patient care) experience.
• 1 year of utilization review (or other medical management experience).

Desired Qualifications:

• Computer skills, InterQual, ASAM, Milliman criteria experience preferred.

Salary Range: $69,000 - $95,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.

We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!

Comagine Health’s mission is to work together with our partners to improve health and create a better health care system so that people and communities will flourish. As part of our mission and values, we recognize the importance of having our employees vaccinated against COVID-19- both as a protection for our larger community and to keep our employees and their families safe.

As a federal contractor, and in compliance with Executive Order 14042, Comagine Health requires its employees and contractors to be fully vaccinated against COVID-19 (including any booster shots if required), unless they are approved for a reasonable accommodation based on medical condition or religious belief that prevents them from being vaccinated. Being fully vaccinated against COVID-19 is a condition of employment at Comagine Health.

• If you are fully vaccinated, you will be required to provide proof of your completed COVID-19 vaccination prior to the first day of your employment. Failure to provide timely proof of your COVID-19 vaccination status may result in your offer of employment being rescinded or your start being delayed.
• If you are unable to be fully vaccinated due to medical condition or religious belief, you will be required to request an exemption upon acceptance of the offer of employment. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an exemption is not approved, then your offer of employment may be rescinded.

Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability