Clinical Reviewer Lead

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.

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. The Clinical Reviewer Lead will analyze complex clinical data to identify trends, improve processes, and support decision-making that enhances patient care outcomes. Ultimately, this role ensures that clinical reviews are conducted with integrity, accuracy, and efficiency, contributing to the overall success of healthcare service delivery in the Washington DC area.

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.