Clinical Reviewer Registered Nurse; RN State

Clinical Reviewer Registered Nurse (RN) Washington State.

Washington, US

Salary Range: $80,000.00 To $ Annually

Comagine Health | Washington State | Remote / Work From Home

Department: Care Management
Contract: Washington Labor & Industries (L&I)
Location: Washington State – Remote
Employment Type: Full-Time

This is an excellent opportunity for an experienced Registered Nurse who wants to transition from direct patient care into a remote clinical review role or continue building a career in clinical review and healthcare quality.

At Comagine Health, we are passionate about improving the quality, safety, and value of healthcare. As a national nonprofit healthcare consulting organization, we partner with healthcare providers, government agencies, and communities to improve health outcomes and ensure individuals receive appropriate, high-quality care.

Our mission-driven culture provides opportunities for healthcare professionals to apply their clinical expertise in meaningful ways while enjoying the flexibility of a remote work environment.

We are seeking an experienced
Clinical Reviewer (Registered Nurse) to support our Washington Labor & Industries (L&I) contract. This position offers an opportunity to use your nursing experience and clinical judgment to evaluate healthcare services, promote evidence-based care, and make a meaningful difference in healthcare quality.

Remote work opportunity within Washington State

Comprehensive medical, dental, and vision insurance

401(k) retirement plan with company match

Generous paid time off and paid holidays

Annual home office stipend, provided through payroll in January for existing employees and upon hire for new employees

Professional development and continuing education opportunities

Collaborative, supportive, and mission-driven work environment

Opportunity to make a meaningful impact on healthcare quality and patient outcomes

The
Clinical Reviewer is responsible for assessing the medical necessity, appropriateness, and quality of healthcare services through prospective, concurrent, and retrospective clinical reviews.

In this role, you will apply your clinical knowledge, evidence-based guidelines, and established review criteria to evaluate healthcare services and support appropriate clinical decision-making.

You will collaborate with physician consultants, clinical professionals, and internal teams to ensure reviews are completed accurately, consistently, and in accordance with contractual and regulatory requirements.

This is an excellent opportunity for an experienced Registered Nurse who wants to transition from direct patient care into a remote clinical review role or continue building a career in clinical review and healthcare quality.

Clinical Reviews & Medical Necessity Determinations

Conduct prospective (pre-authorization), concurrent (continued stay), and retrospective clinical reviews for inpatient and outpatient services, including orthopedic and spine surgery and complex imaging.

Evaluate healthcare service requests to determine whether established clinical criteria are met and assess the appropriateness of care.

Apply established clinical review criteria, organizational policies, regulatory requirements, and evidence-based guidelines.

Review clinical documentation and medical records to support accurate and timely determinations.

Clinical Consultation & Collaboration

Consult with physician and practitioner consultants when cases do not meet established clinical review criteria.

Refer cases to appropriate clinical professionals for additional evaluation when indicated.

Collaborate…