Clinical Reviewer

Comagine Health

. Assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews .

Posted 9/17/2026full-timeRemote • Alaska • United StatesMid-LevelSenior💰 $79,000 - $104,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical review and utilization management, applying InterQual criteria and organizational policies to ensure compliance and quality of care. Proficient in communication and collaboration with healthcare providers and stakeholders to support effective healthcare delivery.

Highest-signal resume keywords

Clinical Review ExpertiseUtilization ManagementInterQual Criteria ExperienceRN LicenseMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewUtilization Management ReviewsInterQual Screening ToolsDocumentation CompliancePatient Care ExperienceDatabase Systems FamiliarityAnalytical SkillsProblem-Solving AbilitiesRemote Work CapabilityRegulatory Compliance

Soft Skills

Excellent Communication SkillsOrganizational SkillsTeam CollaborationAbility to Manage Multiple PrioritiesOutreach and Engagement

Tools & Technologies

Microsoft Office SuiteVirtual Communication ToolsComputersPhones

Certifications & Qualifications

Active RN LicenseLicensure Eligibility for Assigned State Contract

Industry Keywords

Healthcare ServicesMedical NecessityQuality of CareAlaska-Specific Contract RequirementsProvider Outreach

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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
Current, active, unrestricted RN license
Must meet Alaska state and contract-specific requirements
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
Ability to sit for extended periods and communicate effectively
Valid driver's license and driving eligibility requirements where applicable

Benefits

Comp & perks

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
Annual stipend for workspace enhancement
Remote work support
Work-life balance
Reasonable accommodations for individuals with disabilities