Clinical Reviewer (RN) Qualified Intellectual Disabilities Pro

COMAGINE HEALTH

3d • Remote

About The Position

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.

We believe in an environment that allows you to thrive both personally and professionally.

We are seeking an RN to perform Clinical Review work and QIDP reviews work.

Team member will serve as the QIDP (.5 FTE) and as a nurse clinical reviewer (.5 FTE).

Requirements

• BA/BS in Nursing
• Active RN in the Alabama.
• Minimum of 3 years of direct patient care (clinical) experience
• Current, active, unrestricted RN license
• Alabama
• All nurse reviewers will be located and licensed within Alabama and in good standing with the Alabama Board of Nursing and Board of Medical Examiners.
• Reliable, secure internet connection required
• Must maintain licensure eligibility for assigned state contract

Nice To Haves

• Performing PA reviews
• Long-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilities
• Provider relations
• Reporting

Responsibilities

• Apply Alabama Medicaid program criteria and guidelines to determine the medical necessity of health care services.
• Intermediate Care Facilities for Individuals with Intellectual Disabilities [https://www.google.com/search?q=Intermediate+Care+Facilities+for+Individuals+with+Intellectual+Disabilities&rlz=1C1CHZN_enUS1078US1078&oq=ICF%2FIID+experience&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIGCAEQRRg60gEJMTc0NGowajE1qAIIsAIB8QV3spwCSPSArvEFd7KcAkj0gK4&sourceid=chrome&ie=UTF-8&ved=2ahUKEwjW5uyt9u2TAxV2nCYFHbTVC64QgK4QegQIARAB] experience.
• Complete reviews within timelines established by all applicable state and federal requirements.
• Consult and forward to a Physician Advisor/ Consulting Physician all cases for which a medical necessity determination cannot be rendered.
• Work with administrative support, as appropriate.
• Identify customer needs and expectations and responds to them in a timely and effective manner.
• Anticipate and prevent delays or other adverse impacts to customers and keep them informed about the status of pending actions and inquiries.
• Attend, upon request, Medicaid meetings, fair hearings, meetings, and hearings of legislative committees and interested governmental bodies, agencies, and officers.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees