Comagine Health

Manager

• Provide operational supervision of clinical staff conducting utilization review and specialty review activities
• Guide, train, and support clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services
• Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, organizational policies, and regulatory guidelines
• Supervise utilization management, care coordination, and/or case management activities
• Ensure quality, compliance, timeliness, and contractual performance standards are met
• Serve as an escalation point for complex clinical or operational concerns
• Communicate significant issues to leadership
• Support quality management initiatives, audits, training efforts, and continuous improvement activities
• Conduct onboarding, coaching, performance management, and ongoing staff development
• Review and approve timecards and operational documentation
• Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities
• Support organizational goals and accreditation standards

Clinical Case Manager, Supervisor

Medical Reviewer

• Assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews
• Apply clinical review criteria, organizational policies, guidelines, and InterQual screening tools
• Consult physician/practitioner consultants when services do not meet medical necessity criteria
• Collaborate with internal teams and refer cases for additional review or escalation
• 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 regulatory and contract standards
• Support high-quality, appropriate, and cost-effective care while ensuring compliance with clinical criteria, organizational policies, and Alaska-specific contract requirements
• Work remotely in a home-based setting using computers, phones, and virtual communication tools
• Occasional travel for meetings, training, or work-related events may be required

Clinical Reviewer

Research Analyst

• Manage and implement research studies and evaluation projects
• Perform standardized research and evaluation activities with minimal oversight
• Develop project materials and support dissemination
• Organize project materials, take meeting minutes, and maintain logs of compliance-related documents
• Contribute to analysis and reporting with minimal oversight, including quantitative and qualitative data and data visualization techniques
• Serve as task lead or project manager
• Maintain project plans, timelines, and deliverable schedules
• Conduct and potentially lead data collection, including surveys, interviews, field observations, site visits, and focus groups

Clinical Case Manager, Supervisor

Clinical Reviewer

Research Associate II