Comagine Health
Las Vegas, NV
The PRN/part-time position requires availability for at least two four-hour shifts per week. The hours are not limited. Weekend hours are available. Clinical Reviewers work from an electronic review queue to evaluate applicable authorization requests and supporting medical records for medical necessity and appropriateness. They apply workers’ compensation treatment guidelines, clinical criteria, and organizational policies to approve cases when appropriate or refer cases requiring additional review to Medical Affairs and physician reviewers. Reviewers research applicable treatment guidelines, document decisions and supporting rationale. They also manage pended cases, obtain additional information through providers or the claim system, and communicate with clinics. Clinical Reviewers collaborate with physician advisors, providers, and internal teams to support accurate, timely, and well-documented review decisions. If you’re ready to put your clinical expertise and...