COMAGINE HEALTH

Role Description Are you passionate about detail-oriented work that keeps processes running smoothly and accurately? Do you enjoy piecing together information, working across multiple systems, and playing a key role in supporting high-quality outcomes? In this remote Intake Representative role, you will work in a fully electronic environment, reviewing incoming requests for utilization review and other medical management services, verifying that documentation is complete and accurate, and ensuring cases are ready for clinical review. Your work involves: - Using an electronic medical record system and other platforms to validate eligibility. - Confirming claim and provider information. - Comparing documentation across sources. - Following up as needed to gather missing details. - Balancing queue-based work with inbound calls. - Managing priorities independently throughout the day. We’re looking for someone with a strong healthcare support background, including comfort with medical terminology, documentation review, and validating detailed information for accuracy and completeness. If you are naturally curious, able to work independently, and bring a high level of attention to detail and consistency in your work, we encourage you to apply. You must reside in the Mountain Time Zone and be available to work Monday through Friday, 8:00 AM to 5:00 PM, MST. Qualifications - High school diploma or equivalent or equivalent combination of education and/or work experience in related field may be substituted. - 2 years of related work experience or customer service experience. - 1 year of work experience in healthcare. - Post-secondary education or certification in a related field preferred. - 2 years of work experience in healthcare; nursing assistant or medical assistant experience. Requirements - Intermediate understanding of medical terminology. - Intermediate Microsoft Office Suite proficiency. - Demonstrated proficiency with medical terminology. - Participates in orientation and training of other Intake staff. Benefits - 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! Company Description 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.

Role Description The Clinical Review Supervisor provides operational supervision of clinical staff conducting utilization review and specialty review activities. This role is responsible for guiding, training, and supporting clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services. The supervisor also supports operational excellence through quality oversight, staff development, regulatory compliance, and collaboration with internal and external stakeholders. While this is a fully remote position within the United States, the work hours are going to be based on the Pacific Standard Time zone. Key Responsibilities - Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, an evidence-based clinical criteria tool, organizational policies, and regulatory guidelines. - Supervise utilization management, care coordination, and/or case management activities to ensure quality, compliance, timeliness, and contractual performance standards are met. - Serve as an escalation point for complex clinical or operational concerns and communicate significant issues to leadership appropriately. - Support quality management initiatives, audits, training efforts, and continuous improvement activities. - Conduct onboarding, coaching, performance management, and ongoing staff development activities. - Review and approve timecards and operational documentation as needed. - Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities. - Maintain a strong customer service focus while supporting organizational goals and accreditation standards. Qualifications - Associate degree (AA/AS) - Current, active, unrestricted RN license - 5 years of direct patient care clinical experience - 1 year of utilization review or medical management experience - Strong communication, problem-solving, organizational, and customer service skills - Ability to lead teams in a remote work environment Preferred Qualifications - Bachelor’s degree (BA/BS) - Prior supervisory or team leadership experience - Experience working within managed care, healthcare consulting, or payer environments - InterQual experience Benefits - 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 - Annual remote work stipend - And much more! Company Description Comagine Health is a national, mission-driven nonprofit healthcare consulting organization dedicated to improving health and healthcare quality across the United States. For more than 50 years, we have partnered with providers, payers, communities, and government organizations to improve patient outcomes and strengthen healthcare systems. Our talented remote workforce spans the country, and we actively support flexible remote work while fostering collaboration, innovation, and professional growth. We are committed to creating meaningful work that improves lives.

Role Description Comagine Health is seeking an Improvement Advisor to join our HSI team. In this role, you will collaborate with health care providers, community organizations, and stakeholders to support initiatives that improve care delivery, patient safety, and population health outcomes. The Improvement Advisor provides consulting and technical assistance to a variety of health care partners—including hospitals, practices, long-term care facilities, home health agencies, and community-based organizations—to support health system transformation and performance improvement initiatives. Key Responsibilities - Guide organizations through quality improvement and practice transformation initiatives - Coach stakeholders on data collection, interpretation, and performance improvement strategies - Design and implement evidence-based quality improvement interventions - Facilitate learning collaboratives, trainings, and stakeholder engagement meetings - Partner with interdisciplinary teams to support patient safety, community engagement, and population health initiatives - Track and document activities using CRM and project management tools Qualifications - Bachelor’s degree in public health, health care, or a related field - 4+ years of health care experience, including quality improvement work - 2+ years of project management experience - Previous outpatient clinic experience preferred - Strong knowledge of quality improvement methods, health care terminology, and clinical workflows - Excellent communication and stakeholder engagement skills Preferred - Master’s degree (MA/MS) in Public Health, Nursing, Health Care Administration, Public Policy, or related field - Deep experience working on quality improvement initiatives with outpatient practices Benefits - 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! Equal Opportunity Employer Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.

Role Description This role requires that the employee is an active RN and based in Alabama. The Supervisor, Clinical Review plays a critical role in providing operational supervision of clinical staff who conduct utilization review and/or specialty reviews. The Clinical Review supervisor will guide, monitor, and train clinical reviewers to identify medical necessity/medical appropriateness as identified by specific criteria, contract guidelines, and/or organizational clinical criteria. Qualifications - All nurse reviewers will be located and licensed within Alabama and in good standing with the Alabama Board of Nursing and Board of Medical Examiners. - Experience with: - Performing PA reviews - Long-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilities - Minimum of 3 years of clinical experience in a healthcare setting. - At least 1 year of supervisory or team leadership experience in a clinical environment. - 1 year of medical management / utilization review experience. - Strong knowledge of clinical review processes, healthcare regulations, and medical terminology. - Proficiency with electronic medical records (EMR) systems and clinical documentation standards. Requirements - Preferred Qualifications: - LCSW, LPC licensure or equivalent clinical certification. - 3 years of medical management / utilization review experience. - Experience with health plan operations or managed care organizations. - Familiarity with state and federal healthcare regulations, including HIPAA and CMS guidelines. - 5 years of clinical (direct patient care) experience. Responsibilities - Display critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable, and excellent communicator. - Demonstrated leadership ability within a team, including management of personnel, meeting targets, and facilitating process improvement efforts. - Competent in understanding medical/clinical terminology, diagnoses, and documentation. Skills - Strong communication and interpersonal skills for collaborating with multidisciplinary teams and resolving clinical issues efficiently. - Analytical skills to interpret clinical data, identify trends, and implement quality improvement initiatives. - Proficiency with EMR systems and clinical software for accurate documentation review and reporting. - Preferred skills such as advanced certifications and familiarity with regulatory frameworks to enhance the supervisor’s ability to navigate complex healthcare environments and drive continuous improvement in clinical review processes. Benefits - 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!

Role Description Are you inspired by work that helps people maintain access to critical services? Do you find purpose in supporting individuals and families through person-centered care? If so, consider joining our team as a Home and Community-Based Services (HCBS) Assessor. In this part-time role (20 hours per week), you’ll conduct annual in-home assessments across the southeast New Mexico region with adults receiving services through the New Mexico Mi Via Waiver. You’ll manage a flexible, primarily field-based schedule—visiting participants’ homes, completing assessments, and using your home office for follow-up, scheduling, and documentation. During each visit, you’ll: - Build meaningful rapport with participants and their families or caregivers. - Administer a structured assessment tool using our electronic systems. - Gather detailed information about daily living skills, behaviors, and support needs. - Translate observations into accurate, clear documentation that helps ensure individuals maintain access to community-based services. You’ll also be part of a growing, collaborative team of assessors with opportunities to learn, develop, and make a real impact every day. This is a 0.50 FTE part-time position working 20 hours per week and is benefits-eligible. The person must be located in the Farmington, New Mexico area in order to travel to participant homes for assessments. Note- salary is prorated per the FTE. Qualifications - Associate's degree in social work, psychology, or other behavioral health science field. - 2 years of social service, case management or other relevant work experience. - Valid, unrestricted driver license, proof of auto insurance and reliable transportation. - Ability to pass a Motor Vehicle Record check. Requirements - Manage your schedule to complete in-home assessments across the Farmington, New Mexico region using your personal vehicle. - Coordinate and schedule annual in-home assessments including making outreach and follow-up calls to participants and families, confirming appointments, and maintaining an organized calendar. - Conduct person-centered, face-to-face assessments in participants' homes, which may include adults with intellectual and developmental disabilities and/or their caregivers, using assessment tools to gather information on daily living skills, behaviors, and functional abilities. - Navigate and use multiple technology platforms (e.g., online assessment tools, data systems, PDFs, Microsoft Office) to document findings, complete templates, upload assessments, and accurately close out each case in a timely manner. - Ensure all work complies with confidentiality and HIPAA requirements, including safeguarding participant information and following established policies and procedures for handling sensitive data. - Communicate with your supervisor, program coordinator, and assessor colleagues to report on your work and discuss cases. - Participate in training and team meetings. Benefits - 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! Company Description 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.

Role Description Comagine Health is seeking a Consultant to support our Health System Improvement team, with a focus on Long Term Care Facilities. In this role, you will provide consulting services across clinical, operational, public health, and quality improvement domains to help clients navigate the evolving health care landscape and improve outcomes. Minimum hours 15 per week; potential to flex to 40 based on project needs. This position serves as a subject matter expert, leading projects, engaging stakeholders, and delivering impactful solutions that strengthen health systems, particularly within long-term care and skilled nursing environments. Services will be provided through a combination of on-site and virtual support. Key Responsibilities - Consulting & Program Delivery (60%) - Lead and deliver consulting services across long-term care facilities - Facilitate meetings, strategy sessions, and learning collaboratives - Design and implement health system improvement initiatives, with emphasis on quality and regulatory performance in long term care facilities - Develop and deliver training curricula, educational programs, and large-scale improvement efforts - Project Leadership & Management (30%) - Lead project planning, execution, and delivery with strong client focus - Define project scope, goals, and deliverables in collaboration with internal teams and clients - Develop and manage project plans, timelines, and milestones - Monitor progress, track deliverables, and provide status reporting - Maintain project documentation including meeting notes, schedules, and reports - Business Development & Thought Leadership (10%) - Represent Comagine Health at meetings, conferences, and industry events - Present as a subject matter expert at local, state, and national forums - Contribute to proposal development and new business opportunities Qualifications - Experience in health care consulting, quality improvement, public health, or health system transformation - Strong familiarity with Long-term care facility regulatory requirements - Experience working with or supporting long-term care facilities in quality improvement - Demonstrated ability to lead projects and manage multiple priorities simultaneously - Strong facilitation, communication, and stakeholder engagement skills - Experience developing and delivering training or educational content - Ability to work independently in a remote environment - BSN Requirements - Advanced degree (e.g., MPH, MHA, MSN, or related field) - Experience with health system improvement initiatives, population health, or care delivery transformation - Familiarity with long-term care regulations, quality measures, and survey readiness - Prior experience with learning collaboratives or large-scale improvement programs Work Environment - Travel 25-50% of work - Remote when not traveling, U.S.-based - Minimum hours 15 per week; potential to flex to 40 based on project needs Equal Opportunity Employer Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.

Role Description We are seeking a Database Administrator II to support the administration, monitoring, and optimization of the organization’s SQL database environments. This role is responsible for ensuring databases remain secure, high-performing, and recoverable, while supporting both on-premises and cloud-based database systems. The Database Administrator II will work closely with developers, architects, and infrastructure teams to maintain database performance, troubleshoot issues, and support database migrations and improvements across environments. Key Responsibilities - Database Administration & Design - Administer and maintain SQL databases across development, test, and production environments. - Collaborate with developers and system architects to design scalable and efficient database solutions. - Optimize database structures to ensure performance, reliability, and data integrity. - Performance Monitoring & Optimization - Monitor database health and performance to ensure systems remain accessible and efficient. - Identify performance bottlenecks and implement database and query optimization strategies. - Security & Compliance - Implement database security policies and procedures to protect sensitive data. - Ensure database environments meet security and regulatory requirements. - Backup, Recovery & High Availability - Develop and maintain database backup and recovery processes. - Support high availability solutions such as clustering and Always On Availability Groups. - Participate in disaster recovery planning and testing. - Automation & Scripting - Develop and maintain scripts for database monitoring, automation, and maintenance tasks. - Identify opportunities to automate operational processes. - Cloud & Database Migration - Support migration of on-premises SQL Server databases to cloud platforms such as Microsoft Azure or AWS. - Evaluate and recommend cloud-based database services to improve scalability and performance. - Amazon Redshift Administration (Preferred) - Assist with administration and optimization of Amazon Redshift clusters, including performance tuning and cluster monitoring. Qualifications - Education: Bachelor’s degree in Computer Science, Information Technology, or a related field, or equivalent experience. - Required Certification: Microsoft Certified: Azure Database Administrator. - Experience: 5+ years of experience in database administration, database architecture, or related technical roles. - Preferred Certifications: - Microsoft Certified: SQL Server Database Administrator - Microsoft Certified: Azure Database Migration Engineer - AWS Certified Database – Specialty - Technical Skills: - Advanced experience with SQL Server database administration. - Expertise in database performance tuning and troubleshooting. - Strong proficiency in T-SQL scripting and automation. - Experience with high availability and disaster recovery solutions. - Familiarity with Azure SQL Database, Amazon RDS, or similar cloud database services. - Exposure to Amazon Redshift architecture, clusters, and optimization preferred. - Additional Skills: - Strong analytical and problem-solving abilities. - Excellent communication and collaboration skills. - Ability to work effectively in a fully remote, distributed team environment. Benefits - 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! Company Description 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.

Role Description Comagine Health partners with the Oregon Health Authority (OHA) to provide statewide eligibility determination, service coordination, medical appropriateness reviews, and transition planning for individuals diagnosed with serious and persistent mental illness (SPMI). Our goal is to support adults with SPMI to live in the least-restrictive settings possible by ensuring that necessary and desired supports and services are in place. This important work is accomplished through: - Administering face-to-face assessments and person-centered service planning (in partnership with individuals and their designated agents) - Continuous monitoring of service plans - Assisting with transitions from and between community and institutional settings Qualifications - 2+ years of clinical experience that includes conducting assessments, gathering histories, conducting examinations and providing DSM 5 diagnoses, and developing treatment and safety plans for individuals with severe and persistent mental illness (SPMI) - Qualified Mental Health Professional (QMHP) or provide proof of QMHP application at the time an offer is extended, and certification is obtained within 2 weeks following date of employment; or current, active, unrestricted clinical licensure in Oregon state Requirements - As travel is required, the ideal location for residency is in Eugene, Oregon - Candidates must reside in the geographic area and be willing to travel in their personal vehicle up to 25% of the time to perform in person assessments Benefits - 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! Company Description 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. In short, we are changing health care at a fundamental level.

Role Description Are you passionate about detail-oriented work that keeps processes running smoothly and accurately? Do you enjoy piecing together information, working across multiple systems, and playing a key role in supporting high-quality outcomes? In this remote Intake Representative role, you will work in a fully electronic environment, reviewing incoming requests for utilization review and other medical management services, verifying that documentation is complete and accurate, and ensuring cases are ready for clinical review. Your work involves: - Using an electronic medical record system and other platforms to validate eligibility. - Confirming claim and provider information. - Comparing documentation across sources. - Following up as needed to gather missing details. - Balancing queue-based work with inbound calls. You must reside in the Pacific Time Zone and be available to work Monday through Friday, 8:00 AM to 5:00 PM, PST. Qualifications - High school diploma or equivalent or equivalent combination of education and/or work experience in related field may be substituted. - 2 years of related work experience or customer service experience. - 1 year of work experience in healthcare. Requirements - Intermediate understanding of medical terminology. - Intermediate Microsoft Office Suite proficiency. - Demonstrated proficiency with medical terminology. Benefits - 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! Responsibilities - Validate the request submitted via the Comagine Health Provider Portal for accuracy and completeness. - Screen cases for required medical information based on type of request, determining if information is sufficient for clinical review. - Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review. - Determine based on training when a scripted review is indicated based on contract requirements. - Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers. - Respond to inbound telephone requests with clear documentation in the care management system of calls. - Enter case information from original source documentation or validate information entered by providers in the portal. - Make courtesy calls with case reference numbers. - Provide notification of completed review and additional information needed, when applicable. - Contribute to orientation and training of other non-clinical employees. - Create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities as requested. - May perform scripted clinical reviews and refer reviews requiring further action to clinical review staff. - After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract. - Complete case after physician review, returning to clinician or sending to client based on procedure. - Arrange ancillary authorization requests such as transportation and accommodation. - Obtain customer consent for care management services to be performed. - Correspond with facilities, providers, and others. - Coordinate non-clinical functions and intervention, as directed. - Perform supervised closure of cases upon completion of review by a clinical reviewer, as directed. Physical Requirements & Work Environment This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods and communicate effectively. Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver’s license and meet the organization’s driving eligibility requirements. Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Intake Representative assists providers in submitting documentation for case management, utilization review, and other medical management services. This role is responsible for entering case information, validating documentation for completeness, and communicating with providers regarding case status and required information. The Intake Representative plays an important role in ensuring requests are accurately documented and ready for clinical review while maintaining clear communication with providers and internal teams. Key Responsibilities - Validate requests submitted through the Comagine Health Provider Portal for accuracy and completeness. - Screen cases for required medical information and determine if documentation is sufficient for clinical review. - Obtain additional information from providers or client systems when necessary. - Enter and validate case information within the care management system. - Respond to inbound provider calls and document interactions appropriately. - Conduct outbound calls to providers regarding case status, additional documentation needs, or review outcomes. - Process requests after physician review, ensuring determination language and documentation are complete before sending notifications. - Notify providers of review outcomes, additional information needed, or potential denial of services as required by contract. - Participate in orientation and training of other intake staff. - Support internal quality review processes and provider outreach activities as requested. Additional Responsibilities (Case Management Support) - Arrange ancillary authorization requests such as transportation or accommodations when applicable. - Obtain customer consent for care management services. - Coordinate non-clinical activities with providers, facilities, and other stakeholders. - Assist with case closure activities following review by clinical staff. Qualifications - High school diploma or equivalent. - Equivalent combination of education and relevant work experience may be considered. Requirements - 2 years of related work or customer service experience. - 1 year of healthcare experience. Preferred Qualifications - Post-secondary education or certification in a related field. - 2 years of healthcare experience. - Experience as a medical assistant, nursing assistant, or similar healthcare support role. Skills and Competencies - Intermediate understanding of medical terminology. - Proficiency with Microsoft Office Suite. - Strong communication and customer service skills. - Ability to document information accurately in a care management system. - Ability to manage multiple tasks and communicate effectively with providers and internal teams. Benefits - 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! Equal Opportunity Employer Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.