Clinical Reviewer, PRN Anywhere

1042 Company: Comagine Health Employment Type: PRN Role Overview Comagine Health is seeking a Clinical Reviewer - On-Call - PRN (less than 20 hours per week) to assess the medical necessity, quality, and appropriateness of healthcare services. This role conducts prospective, concurrent, and retrospective utilization management reviews to support high-quality, cost-effective care while ensuring compliance with evidence-based guidelines, regulatory requirements, and organizational policies.

Key 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.

Qualifications

Education

• Bachelor’s degree (BA/BS) required
• BS in Nursing Licensure
• Current, active, unrestricted clinical licensure required Experience
• Minimum of 3 years of clinical (direct patient care) experience
• 1 year of utilization review or medical management experience preferred Core Competencies
• Intermediate communication skills
• Intermediate interpersonal and relationship-building skills
• Foundational professionalism and integrity
• Foundational work ethic and reliability
• Intermediate clinical knowledge Why Join Comagine Health? At Comagine Health, we partner with healthcare organizations to improve outcomes and optimize care delivery. This role offers the opportunity to apply your clinical expertise in a broader population-health setting while contributing to meaningful, quality-driven healthcare decisions.

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