Clinical Reviewer, Registered Nurse (RN)
Comagine Health
Posted: 10/21/2026
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Comagine HealthPosted 10/21/2026full-timeRemote • Washington • United StatesMid-LevelSenior💰 $80,000 - $100,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting clinical reviews for inpatient and outpatient services, applying clinical judgment, and ensuring compliance with healthcare standards. Proficient in evaluating medical documentation and collaborating with clinical teams to enhance review practices.
Highest-signal resume keywords
Registered Nurse (RN) LicenseClinical Nursing ExperienceClinical Assessment SkillsElectronic Medical Records ProficiencyMedical Necessity Criteria Familiarity
About the role
Key responsibilities & impact- Conduct prospective (pre-authorization), concurrent (continued stay), and retrospective clinical reviews for inpatient and outpatient services, including orthopedic and spine surgery and complex imaging
- Evaluate healthcare service requests to determine whether established clinical criteria are met and assess the appropriateness of care
- Apply established clinical review criteria, organizational policies, regulatory requirements, and evidence-based guidelines
- Review clinical documentation and medical records to support accurate and timely determinations
- Consult with physician and practitioner consultants when cases do not meet established clinical review criteria
- Refer cases to appropriate clinical professionals for additional evaluation when indicated
- Collaborate with internal clinical teams to support consistent, high-quality review practices
- Ensure clinical reviews are appropriately documented and completed in accordance with established procedures and contractual expectations
- Support compliance with Washington L&I contract requirements and applicable clinical review standards
- Provide daily oversight and monitoring of non-clinical support activities, as appropriate
- Offer feedback to supervisors regarding the performance and effectiveness of non-clinical support processes
- Contribute to continuous quality improvement initiatives and efficient review operations
Requirements
What you’ll need- Current, active, unrestricted Registered Nurse (RN) license in the State of Washington
- Minimum of five (5) years of clinical nursing experience providing direct patient care
- Experience applying clinical judgment to evaluate patient care, treatment plans, and medical documentation
- Ability to interpret and apply clinical guidelines, medical necessity criteria, and established healthcare standards
- Strong clinical assessment and critical-thinking skills
- Excellent written and verbal communication skills
- Ability to review and interpret complex clinical documentation
- Strong organizational skills with attention to detail and accuracy
- Ability to work independently, prioritize responsibilities, and meet established deadlines
- Proficiency with electronic medical records, clinical documentation systems, and computer-based applications
- Demonstrated professionalism, reliability, and commitment to confidentiality
- Bachelor's degree (BA/BS) is preferred
- Clinical experience in an Intensive Care Unit (ICU) and/or Emergency Department (ER) setting is preferred
- Familiarity with medical necessity criteria and evidence-based clinical guidelines is preferred
- Experience collaborating with physician reviewers and multidisciplinary clinical teams is preferred
- Reliable internet access and a dedicated workspace free from significant distractions
- Ability to maintain the confidentiality of protected health information
- Comfort using electronic medical records, clinical review applications, and virtual communication tools
Benefits
Comp & perks- Remote work opportunity within Washington State
- Comprehensive medical, dental, and vision insurance
- 401(k) retirement plan with company match
- Generous paid time off and paid holidays
- Annual home office stipend
- Professional development and continuing education opportunities
- Collaborative, supportive, and mission-driven work environment
- Opportunity to make a meaningful impact on healthcare quality and patient outcomes
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewPatient Care EvaluationClinical Documentation ReviewCritical ThinkingOrganizational SkillsAttention to DetailClinical Guidelines InterpretationHealthcare Standards ApplicationQuality Improvement InitiativesRegulatory Compliance
Soft Skills
Excellent Communication SkillsProfessionalismReliabilityConfidentiality CommitmentIndependent Work Ability
Tools & Technologies
Clinical Documentation SystemsElectronic Medical RecordsClinical Review ApplicationsVirtual Communication Tools
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
Orthopedic SurgerySpine SurgeryIntensive Care Unit (ICU)Emergency Department (ER)Washington L&I ComplianceEvidence-Based GuidelinesHealthcare Service RequestsClinical Review Standards