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Comagine Health · 1 day ago

Clinical Reviewer

United States

Part-time

Remote

Mid Level

$37/hr - $45/hr

3+ years exp

Comagine Health is seeking a Clinical Reviewer - On-Call - PRN to assess the medical necessity, quality, and appropriateness of healthcare services. This role involves conducting utilization management reviews to support high-quality, cost-effective care while ensuring compliance with guidelines and regulations.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

Responsibilities

Conduct prospective (pre-authorization), concurrent/continued stay, and retrospective utilization management reviews to ensure appropriate use of healthcare resources

Conduct compliance and/or quality audits of medical records/patient charts for accuracy, completeness, and adherence to established standards

Evaluate requests for healthcare services using clinical review criteria, organizational policies, regulatory requirements, and evidence-based guidelines to determine medical necessity and appropriateness

Perform compliance and quality audits of medical records and patient charts for accuracy, completeness, and adherence to established standards

Consult with physician or practitioner consultants when reviews do not meet clinical criteria and refer cases to other clinicians as appropriate

Provide day-to-day oversight and monitoring of non-clinical staff performing non-clinical support activities, as applicable, and offer performance feedback to the supervisor

Qualification

Clinical licensureClinical knowledgeUtilization review experienceDirect patient care experienceProfessionalismCommunication skillsInterpersonal skillsWork ethic