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Qualis Health Clinical Reviewer WA L&I in Seattle, Washington

Clinical Reviewer WA L&I Category Care Management Job Location Nationwide Tracking Code 2023-014 Industry Select Industry Job Level Mid Career Position Type Full-Time/Regular Years of Experience 2+ to 5 Years At Comagine Health, our utilization management best practices assure that patients receive the right care, in the right setting, at the right time, thereby avoiding the overuse, misuse and underuse of health services. We provide web-based utilization reviews and targeted review programs based on extensive data analysis. We are seeking a remote Clinical Review RN to join our team supporting Washington State\'s Labor & Industries department. Because of our contractual requirements for RN reviewer coverage until at least 5pm pacific time, we are looking for Nurses who reside in the Pacific or Mountain time zones. Who is the Comagine Health? Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level. What you\'ll be doing for us: Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations. Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services. Consult with physicians or refer cases to others, when indicated. Competencies: Intermediate MS Office Suite proficiency. Have a natural curiosity and desire to learn with attention to detail. Ability to work independently with minimal supervisor in a quality and or productivity driven team-oriented environment. Required Qualifications: Degree or diploma in nursing Current, active, unrestricted RN license in Washington state. 3+ years of clinical (direct patient care) work experience that includes critical care, ED, and/or intensive care. Please note that this position is available to RNs who are open to working the Pacific and Mountain time zones, Monday - Friday. Salary Range: \$70,000 - \$95,000 The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience. We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program! Comagine Health\'s mission is to work together with our partners to improve health and create a better health care system so that people and communities will flourish. As part of our mission and values, we recognize the importance of having our employees vaccinated against COVID-19- both as a protection for our larger community and to keep our employees and their families safe. As a federal contractor, and in compliance with Executive Order 14042, Comagine Health requires its employees and contractors to be fully vaccinated against COVID-19 (including any booster shots if required), unless they are approved for a reasonable accommodation based on medical condition or religious belief that prevents them from being vaccinated. Being fully vaccinated against