Behavioral Health Case Manager/ Clinical Reviewer (Oregon)

Preferra Insurance; Jackson (MS); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO

Retirement plan

Adoption assistance

Parental leave

Job summary

Comagine Health is seeking Behavioral Health / Clinical Reviewer roles across Oregon, with travel to client sites and home-based work. Review clinical documentation for medical necessity, perform utilization reviews, and coordinate care for children, youth, and adults in home and community settings.

The positions require licensure and appropriate clinical credentials, with statewide travel across Oregon. The team emphasizes collaboration, accountability, and effective use of technology to

Qualifications

• QMHP or active, unrestricted licensure as required by Oregon contract
• Master's degrees in psychology/counseling/social work or in physical/occupational therapy
• Minimum 3 years of direct clinical experience in behavioral health

Responsibilities

• Review clinical documentation to determine medical necessity and appropriateness of services
• Perform initial and continued stay reviews using evidence-based criteria
• Document utilization review determinations accurately in designated systems
• Travel for in-person assessments as needed within assigned region
• Support quality assurance activities and audits

Skills

Clinical documentation review

Utilization review

Communication skills

Organizational skills

MS Office

Interpersonal skills

Problem solving

Education

QMHP licensure OR clinical licensure

Master's in psychology, counseling, or social work

Master's in physical or occupational therapy

Tools

MS Office

Database software

EMR systems

Job description

Are you passionate about improving access to behavioral health services in the community? Do you enjoy using your clinical expertise to evaluate needs, support care decisions, and help individuals receive the right services at the right time?

We're recruiting for several Behavioral Health / Clinical Reviewer roles across Oregon. Targeted areas include Portland metro, Eugene, and Salem. Candidates from elsewhere in Oregon are encouraged to apply.

In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms impact daily living, and support service coordination that connects children, youth, and adults to in-home and community-based care. You will manage referrals, follow-ups, reviews, and assessments within an electronic medical record system; apply evidence-based criteria to utilization management reviews; document clinical determinations; provide subject matter expertise to stakeholders; support quality activities and audits; and travel for in-person assessments as needed across your assigned region.

If you are someone who demonstrates strong clinical judgement, builds trusting relationships with members and partners, and effectively manages a high-volume workload while meeting timelines, we encourage you to apply. If you bring a collaborative mindset, accountability in your work, curiosity to ask questions and learn, and comfort using technology to navigate systems and documentation, you will be well-positioned for success on this team. This posting is for several openings across Oregon. Administrative tasks are conducted using company-issued equipment; travel to client sites in Oregon is required.

Why Comagine Health?

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.

We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:

• 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!

You Have (Required Qualifications)

• QMHP OR current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., behavioral health licensure such as LCSW, LPC, LCPC, LPA, PsyD, PhD)
• Master's in physical or occupational therapy OR Master's in psychology, counseling, or social work
• 3 years of clinical (direct patient care) experience; behavioral health preferred

Candidates must reside in Oregon, have personal transportation, and ability to travel. Valid Driver License and Proof of Auto Insurance are required.

You May Have (Desired Qualifications)

• Experience with Medicaid
• Knowledge of the Oregon behavioral health system of care
• 2 years of utilization review or other medical management experience
• 2 years of full-time substance use disorder and/or behavioral health disorder experience

You Bring (Competencies)

• Clinical documentation review expertise, including use of the Oregon Health Plan Prioritized List of Health Services and InterQual
• Strong organizational skills and ability to manage multiple tasks in a team environment
• Excellent oral and written communication skills
• Strong interpersonal and problem-solving skills
• Proficiency with MS Office Suite and familiarity with database software
• Ability to apply clinical review criteria, policies, and guidelines to determine medical necessity
• Ability to document utilization review determinations accurately and timely in designated systems
• Capability to provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns

In this Role, You Will

• Review clinical documentation to substantiate medical necessity and appropriateness for requested services
• Perform initial and continued stay reviews using standardized, evidence-based criteria to ensure services align with individualized behavioral health needs
• Apply clinical review criteria, organizational policies, guidelines, and screening tools to determine medical necessity of healthcare services
• Document utilization review determinations accurately and timely in designated systems
• Consult with physician or practitioner reviewers when cases do not meet clinical review criteria
• Refer cases to other clinicians when appropriate
• Provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns
• Support quality assurance activities, audits, and other program support as assigned
• Provide guidance or oversight to non-clinical staff performing support activities, as appropriate
• Perform other duties as assigned

Work Environment

• Full-Time
• Work is based from your home office
• Travel required
• Reliable, secure internet connection required
• Must maintain licensure eligibility for assigned state contract

Equal Opportunity Employer
Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.

Physical Requirements & Work Environment

This position is partially 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, 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. Occasional travel may be required for meetings, training, or other work-related events.

Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.

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