WI3661943

1

Bachelor's Degree

Bachelors Degree

Unspecified

40

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