Why Comagine Health?
Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.
We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.
Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
We believe in an environment that allows you to thrive both personally and professionally. That’s why we offer benefits that include:
- Medical, dental and vision insurance
- Paid time off for vacation, illness, and volunteering
- Retirement savings plan with employer contribution
- Adoption financial assistance
- Paid parental leave.
- And much more!
We are seeking a Clinical Utilization Review Nurse (RN) to assess the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective utilization management reviews. This full-time, remote position supports high-quality, appropriate, and cost-effective care while ensuring compliance with clinical criteria, organizational policies, and contract requirements specific to Alaska.
Key ResponsibilitiesConduct prospective, concurrent, and retrospective utilization management reviews
Apply clinical review criteria, organizational policies, guidelines, and screening tools (InterQual)
Consult with physician/practitioner consultants when services do not meet medical necessity criteria
Collaborate with internal teams and refer cases for additional review or escalation as appropriate
Refer cases to management when required
Provide clinical and utilization review subject matter expertise
Respond to provider, customer, and stakeholder questions regarding determinations and processes
Conduct outreach to providers, case managers, consultants, and community support coordinators to obtain additional clinical information
Maintain accurate documentation and comply with all regulatory and contract standards
BA/BS in Nursing
An equivalent combination of education and/or related experience may be considered depending on contract
Minimum of 3 years of direct patient care (clinical) experience
Current, active, unrestricted RN license
Must meet Alaska state and contract-specific requirements
Experience with InterQual Criteria
Strong proficiency in Microsoft Office Suite and familiarity with database systems
Excellent written and verbal communication skills
Strong organizational, analytical, and problem-solving abilities
Ability to manage multiple priorities in a fully remote, team-based environment
Full-Time
100% Remote (United States)
Reliable, secure internet connection required
Must maintain licensure eligibility for assigned state contract
Equal Opportunity Employer
Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.
Physical Requirements & Work Environment
This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively.
Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver’s license and meet the organization’s driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events.
Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.
Skills Required
- Bachelor’s degree in Nursing or equivalent education and related experience as permitted by contract
- At least 3 years of direct patient-care clinical experience
- Current, active, unrestricted Registered Nurse license
- Meet Alaska state and contract-specific licensure requirements
- Experience with InterQual Criteria
- Proficiency with Microsoft Office Suite and familiarity with database systems
- Strong written and verbal communication skills
- Strong organizational, analytical, and problem-solving abilities
- Ability to manage multiple priorities in a fully remote, team-based environment
- Reliable, secure internet connection and suitable remote workspace
What We Do
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. Mission: Together with our partners, we work to improve health and create a better health care system so that people and communities will flourish. Get social with us: x.com/comaginehealth facebook.com/comaginehealth Join our team: https://comagine.org/careers Send a message: https://comagine.org/contact
