[Remote] Clinical Reviewer RN - Alabama

Note: The job is a remote job and is open to candidates in USA. Comagine Health is a national, mission-driven, nonprofit organization focused on healthcare quality consulting and improvement services. They are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare services through utilization management reviews.ResponsibilitiesApply Alabama Medicaid program criteria and guidelines to determine the medical necessity of health care servicesComplete reviews within timelines established by all applicable state and federal requirementsConsult and forward to a Physician Advisor/ Consulting Physician all cases for which a medical necessity determination cannot be renderedWork with administrative support, as appropriateIdentify customer needs and expectations and responds to them in a timely and effective mannerAnticipate and prevent delays or other adverse impacts to customers and keep them informed about the status of pending actions and inquiriesAttend, upon request, Medicaid meetings, fair hearings, meetings, and hearings of legislative committees and interested governmental bodies, agencies, and officersSkillsBA/BS in NursingActive RN in AlabamaMinimum of 3 years of direct patient care (clinical) experienceCurrent, active, unrestricted RN license in AlabamaAll Nurse Reviewers Will Be Located And Licensed Within Alabama And In Good Standing With The Alabama Board Of Nursing And Board Of Medical ExaminersExperience With Performing PA reviewsExperience With Long-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilitiesExperience With Provider relationsExperience With ReportingReliable, secure internet connection requiredMust maintain licensure eligibility for assigned state contractBenefitsAn annual stipend gives you the freedom to enhance your workspace with options that suit your needsCompany OverviewComagine Health is a healthcare consulting firm & they work collaboratively with patients, providers, payers and other stakeholders. It was founded in 2018, and is headquartered in Portland, Oregon, USA, with a workforce of 201-500 employees. Its website is https://comagine.org/.