Clinical Reviewer Registered Nurse (RN) Washington State.

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.

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.

• 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.

• 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 with internal clinical teams to support consistent, high-quality review practices.

• Ensure clinical reviews are appropriately documented and completed in accordance with established procedures and contractual expectations.

• Support compliance with Washington L&I contract requirements and applicable clinical review standards.

• Provide daily oversight and monitoring of non-clinical support activities, as appropriate.

• Offer feedback to supervisors regarding the performance and effectiveness of non-clinical support processes.

• Contribute to continuous quality improvement initiatives and efficient review operations.

• Bachelor's degree (BA/BS).

• Clinical experience in an Intensive Care Unit (ICU) and/or Emergency Department (ER) setting.

• Familiarity with medical necessity criteria and evidence-based clinical guidelines.

• Experience collaborating with physician reviewers and multidisciplinary clinical teams.

• Current, active, unrestricted Registered Nurse (RN) license in the State of Washington.

• Strong clinical assessment and critical-thinking skills.

• Excellent written and verbal communication skills.

• Ability to review and interpret complex clinical documentation.

• Strong organizational skills with attention to detail and accuracy.

• Ability to work independently, prioritize responsibilities, and meet established deadlines.

• Proficiency with electronic medical records, clinical documentation systems, and computer-based applications.

• Demonstrated professionalism, reliability, and commitment to confidentiality.

We're looking for a nursing professional who:

• Enjoys applying clinical knowledge and critical thinking to complex healthcare decisions.

• Is detail-oriented and committed to accuracy, consistency, and quality.

• Communicates effectively with physicians, clinical professionals, and colleagues.

• Demonstrates sound clinical judgment and professionalism.

• Thrives in a collaborative environment while working independently.

• Is passionate about improving healthcare quality and ensuring appropriate healthcare services.

This position is remote and requires an active, unrestricted Washington State RN license.

The role is primarily performed in a home-based setting and requires reliable internet access, a dedicated workspace free from significant distractions, and the ability to maintain the confidentiality of protected health information.

Employees must be comfortable using electronic medical records, clinical review applications, and virtual communication tools.

Are you an experienced Registered Nurse looking for an opportunity to apply your clinical expertise beyond the bedside?

At Comagine Health, you'll have the opportunity to use your nursing knowledge to support evidence-based healthcare decisions, promote quality care, and contribute to meaningful improvements in healthcare delivery.

Comagine Health is an Equal Opportunity Employer committed to fostering a diverse, equitable, and inclusive workplace. We provide equal employment opportunities to all qualified applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by applicable federal, state, or local law.