Comagine Health
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Clinical Reviewer Lead
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Comagine Health About Company 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. Benefits 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! About The Role Lead Clinical Reviewer DC Medicaid Contract
The Clinical Review Lead is responsible for designing, implementing, and evaluating reviews by coordinating, delegating, and supporting the Clinical Review team This position serves as a subject matter expert for FFS reviews, as well as Long Term Care reviews for the DC Contract The Clinical Reviewer Lead plays a pivotal role in overseeing the clinical review process to ensure the highest standards of quality and compliance within healthcare services. This position is responsible for leading a team of clinical reviewers, providing expert guidance and support to ensure accurate and timely evaluation of medical records and claims. The role requires collaboration with cross-functional teams to develop and implement review protocols that align with regulatory requirements and organizational goals. Minimum Qualifications Bachelor’s degree in Nursing, Health Sciences, or a related clinical field. Active RN licensure. Minimum of 5 years of clinical review experience within healthcare services. Strong knowledge of medical terminology, clinical documentation, and healthcare regulations. Proven leadership experience managing clinical teams or projects. Excellent analytical, communication, and organizational skills. Preferred Qualifications Master’s degree in Nursing, Healthcare Administration, or a related discipline. Certification in Clinical Documentation Improvement (CDI) or Certified Professional Medical Auditor (CPMA). Experience with electronic health record (EHR) systems and clinical review software. Familiarity with Medicare, Medicaid, and other payer regulations. Experience working in a fast-paced healthcare environment with multidisciplinary teams. Responsibilities Lead and mentor a team of clinical reviewers, providing training, performance feedback, and professional development opportunities. Conduct and oversee detailed clinical reviews of medical records, claims, and related documentation to ensure accuracy and compliance with established guidelines. Collaborate with healthcare providers, auditors, and internal departments to resolve discrepancies and improve review processes. Develop, update, and implement clinical review protocols and quality assurance measures to maintain regulatory compliance and enhance review effectiveness. Analyze clinical data and review outcomes to identify trends, recommend improvements, and support strategic decision-making. Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees. Base pay range : $100,000.00/yr - $115,000.00/yr
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Clinical Reviewer Lead
role at
Comagine Health About Company 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. Benefits 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! About The Role Lead Clinical Reviewer DC Medicaid Contract
The Clinical Review Lead is responsible for designing, implementing, and evaluating reviews by coordinating, delegating, and supporting the Clinical Review team This position serves as a subject matter expert for FFS reviews, as well as Long Term Care reviews for the DC Contract The Clinical Reviewer Lead plays a pivotal role in overseeing the clinical review process to ensure the highest standards of quality and compliance within healthcare services. This position is responsible for leading a team of clinical reviewers, providing expert guidance and support to ensure accurate and timely evaluation of medical records and claims. The role requires collaboration with cross-functional teams to develop and implement review protocols that align with regulatory requirements and organizational goals. Minimum Qualifications Bachelor’s degree in Nursing, Health Sciences, or a related clinical field. Active RN licensure. Minimum of 5 years of clinical review experience within healthcare services. Strong knowledge of medical terminology, clinical documentation, and healthcare regulations. Proven leadership experience managing clinical teams or projects. Excellent analytical, communication, and organizational skills. Preferred Qualifications Master’s degree in Nursing, Healthcare Administration, or a related discipline. Certification in Clinical Documentation Improvement (CDI) or Certified Professional Medical Auditor (CPMA). Experience with electronic health record (EHR) systems and clinical review software. Familiarity with Medicare, Medicaid, and other payer regulations. Experience working in a fast-paced healthcare environment with multidisciplinary teams. Responsibilities Lead and mentor a team of clinical reviewers, providing training, performance feedback, and professional development opportunities. Conduct and oversee detailed clinical reviews of medical records, claims, and related documentation to ensure accuracy and compliance with established guidelines. Collaborate with healthcare providers, auditors, and internal departments to resolve discrepancies and improve review processes. Develop, update, and implement clinical review protocols and quality assurance measures to maintain regulatory compliance and enhance review effectiveness. Analyze clinical data and review outcomes to identify trends, recommend improvements, and support strategic decision-making. Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees. Base pay range : $100,000.00/yr - $115,000.00/yr
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