Clinical Reviewer (RN) Qualified Intellectual Disabilities Pro

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. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the QIDP (.5 FTE) and as a nurse clinical reviewer (.5 FTE). Key Responsibilities Apply Alabama Medicaid program criteria and guidelines to determine the medical necessity of health care services. Intermediate Care Facilities for Individuals with Intellectual Disabilities experience. Complete reviews within timelines established by all applicable state and federal requirements. Consult and forward to a Physician Advisor/ Consulting Physician all cases for which a medical necessity determination cannot be rendered. Work with administrative support, as appropriate. Identify custome