Clinical Reviewer – AK Medicaid – Remote

Clipped from:


Pulled from the full job description

Health insurance

Loan forgiveness

Comagine Health is looking for a remote Clinical Reviewer RN to support Alaska Medicaid and private contracts. In this role, you will work with a variety of patient populations across the organization, providing utilization management and care planning as needed. You will perform utilization management using evidence-based clinical criteria and guidelines to determine the safest and most appropriate medical services for patient populations. While working remotely, you will need to picture yourself at the hospital or bedside to successfully perform this work. You’ll be a part of a remote team working across the country that prides themselves on their collaboration and communication. If this sounds like a role you’d be interested in, we encourage you to read on and apply!


Who is the Comagine Health?

Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.


What you’ll be doing for us:

  • Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.
  • Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.
  • Consult with physicians or refer cases to others, when indicated.


Required Competencies:

  • Professional curiosity and lifelong learner mindset-we cover many contracts with this team and there is always something new!
  • Excellent written communication.
  • Ability to document critical thinking and develop questions for providers regarding decision-making and plan of care.


Required Qualifications:

  • A degree or diploma in Nursing.
  • Current, active, unrestricted RN licensure in good standing.
  • 3+ years of clinical (direct patient care) work experience that includes critical care, ED, and/or intensive care.


Desired Qualifications:

  • 1+ years of utilization review (or other medical management experience) preferred.


Salary Range: $69,000 – $95,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.


We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!


Comagine Health’s mission is to work together with our partners to improve health and create a better health care system so that people and communities will flourish. As part of our mission and values, we recognize the importance of having our employees vaccinated against COVID-19- both as a protection for our larger community and to keep our employees and their families safe.


As a federal contractor, and in compliance with Executive Order 14042, Comagine Health requires its employees and contractors to be fully vaccinated against COVID-19 (including any booster shots if required), unless they are approved for a reasonable accommodation based on medical condition or religious belief that prevents them from being vaccinated. Being fully vaccinated against COVID-19 is a condition of employment at Comagine Health.

  • If you are fully vaccinated, you will be required to provide proof of your completed COVID-19 vaccination prior to the first day of your employment. Failure to provide timely proof of your COVID-19 vaccination status may result in your offer of employment being rescinded or your start being delayed.
  • If you are unable to be fully vaccinated due to medical condition or religious belief, you will be required to request an exemption upon acceptance of the offer of employment. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an exemption is not approved, then your offer of employment may be rescinded.

Required Skills

Required Experience