Clinical Reviewer Registered Nurse (RN) Washington State.
About The Position
Comagine Health is seeking an experienced Registered Nurse to support its Washington Labor & Industries (L&I) contract. The Clinical Reviewer assesses the medical necessity, appropriateness, and quality of healthcare services through prospective, concurrent, and retrospective clinical reviews. The role applies nursing knowledge, clinical judgment, evidence-based guidelines, and established review criteria to evaluate services and support appropriate clinical decision-making. The reviewer collaborates with physician consultants, clinical professionals, and internal teams to ensure reviews are accurate, consistent, timely, and compliant with contractual and regulatory requirements. The position is remote and home-based within Washington State. It requires reliable internet access, a dedicated workspace without significant distractions, and the ability to protect confidential health information. Employees use electronic medical records, clinical review applications, and virtual communication tools. Comagine Health is a national nonprofit healthcare consulting organization that partners with healthcare providers, government agencies, and communities to improve healthcare quality, safety, value, and outcomes.
Requirements
- Current, active, unrestricted Registered Nurse (RN) license in Washington State.
- At least five 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 and 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.
- Professionalism, reliability, and commitment to confidentiality.
- Reliable internet access and a dedicated home workspace free from significant distractions.
- Ability to maintain the confidentiality of protected health information.
Nice To Haves
- Bachelor's degree (BA/BS).
- Clinical experience in an Intensive Care Unit (ICU) and/or Emergency Department (ER) setting.
- Familiarity with medical necessity criteria and evidence-based clinical guidelines.
- Experience collaborating with physician reviewers and multidisciplinary clinical teams.
Responsibilities
- 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 against established clinical criteria and assess the appropriateness of care.
- Apply 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.
- Document clinical reviews and complete them 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.
- Provide supervisors with feedback on the performance and effectiveness of non-clinical support processes.
- Contribute to continuous quality improvement initiatives and efficient review operations.
Benefits
- Comprehensive medical, dental, and vision insurance.
- 401(k) retirement plan with company match.
- Generous paid time off and paid holidays.
- Annual home office stipend, provided through payroll in January for existing employees and upon hire for new employees.
- Professional development and continuing education opportunities.
- Collaborative, supportive, and mission-driven work environment.
- Remote work opportunity within Washington State.
- Opportunity to make a meaningful impact on healthcare quality and patient outcomes.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
