JOB REQUIREMENTS: Clinical Reviewer Category Care Management Job Location remote Tracking Code 134697 Industry Health Care Job Level Mid Career Position Type Full-Time/Regular Years of Experience 5+ to 7 Years Who is Comagine Health? Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system. As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research. We invite our partners and communities to work with us to improve health and redesign the health care delivery system. This is a fully remote position within the United States. Candidates with a Mountain Time Zone location will be considered 1st. Nurses with a utilization background within the DD Waiver field will be considered as a priority. What you\'ll be doing for us: Apply clinical review criteria, guidelines, and screens to determine the medical necessity of health care services. Consult with physician/practitioner consultants when reviews fail clinical review criteria, guidelines, and screens. Refer cases to other professionals internally, including medical affairs consultation, as well as to customers and other appropriate external sources when indicated. Provide clinical and/or review process subject matter expertise; manage complex reviews, respond to customer requests or complaints; monitor and report pertinent observations of clinical performance. Provide initial clinical orientation to new employees as well as ongoing clinical mentoring and support for clinical review staff. Collaborate with the clients to provide clinical expertise on complex cases and or process clarification. Collaborate with Medical Affairs for complex case review and clinical topics. May perform quality assurance audits and program support as assigned. Report HIPAA and or PHI violations in the appropriate Freshservice database As appropriate, provide daily oversight and monitoring of non-clinical staff during their performance of non-clinical support activities; also provide the supervisor with input regarding employees\' performance of these activities. Provide clinical and/or review process subject matter expertise; respond to customer questions or concerns. May perform quality assurance audits and other program support, as assigned. Compensation... For full info follow application link. Equal Employment Opportunity Employment Comagine Health is an Equal Employment Opportunity/Affirmative Action Employer that embraces and practices diversity, reflecting the communities we serve. We encourage minorities, protected veterans and individuals with disabilities to apply. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/E022238556724856