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.

Comagine Health is seeking a Clinical Reviewer - On-Call - PRN (less than 20 hours per week) to assess the medical necessity, quality, and appropriateness of healthcare services. This role conducts prospective, concurrent, and retrospective utilization management reviews to support high-quality, cost-effective care while ensuring compliance with evidence-based guidelines, regulatory requirements, and organizational policies.

• Conduct prospective (pre-authorization), concurrent/continued stay, and retrospective utilization management reviews to ensure appropriate use of healthcare resources.

• Conduct compliance and/or quality audits of medical records/patient charts for accuracy, completeness, and adherence to established standards.

• Evaluate requests for healthcare services using clinical review criteria, organizational policies, regulatory requirements, and evidence-based guidelines to determine medical necessity and appropriateness.

• Perform compliance and quality audits of medical records and patient charts for accuracy, completeness, and adherence to established standards.

• Consult with physician or practitioner consultants when reviews do not meet clinical criteria and refer cases to other clinicians as appropriate.

• Provide day-to-day oversight and monitoring of non-clinical staff performing non-clinical support activities, as applicable, and offer performance feedback to the supervisor.

Education

• Bachelor's degree (BA/BS) required

• BS in Nursing

Licensure

• Current, active, unrestricted clinical licensure required

Experience

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

• 1 year of utilization review or medical management experience preferred

• Intermediate communication skills

• Intermediate interpersonal and relationship-building skills

• Foundational professionalism and integrity

• Foundational work ethic and reliability

• Intermediate clinical knowledge

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.