At Comagine Health, we have a mission: to help patients get the right care, in the right setting and at the right time. We provide web-based utilization management and targeted review programs. Our focus is on patient safety and cost containment, while also leveraging our deep experience and knowledge of evidence-based protocols to deliver appropriate and optimized care. We’re honored to partner with the D.C. Department of Health Care Finance to perform this work on behalf of Medicaid recipients in the District.
- Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.
- Initiate on-site long-term care (LTC) reviews at nursing homes in D.C. plus bordering counties in Maryland and Virginia.
- Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of a variety of healthcare services.
- Consult with physicians or refer cases to others, when indicated.
Required Skills
- BA / BS in nursing (equivalent combination of education and work experience may be substituted).
- Current, active, unrestricted licensure D.C. and Maryland or Virginia.
Required Experience
- 3+ years of clinical experience (med/surg, rehab, skilled nursing, long-term care, and/or home health preferred).
- Prior experience with community-based services (EPD reviews) or nursing home reviews (chart audits) strongly preferred.
- Own transportation to conduct on-site nursing home reviews, as assigned.