Clinical Reviewer

Comagine Health; Oregon (WI); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Paid time off

Retirement savings plan

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health is seeking a Behavioral Health Reviewer based in Oregon. Responsibilities include reviewing clinical documentation for medical necessity, conducting assessments, and managing referrals in a remote capacity. Applicants should possess a relevant master's degree, active clinical licensure, and have at least three years of direct patient care experience. The position also requires personal transportation and ability to travel. Comagine offers a supportive remote work environment with comprehensive benefits.

Qualifications

• 3 years of clinical experience; behavioral health preferred.
• Candidates must reside in Oregon, have personal transportation, and ability to travel.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness.
• Perform initial and continued stay reviews using standardized criteria.
• Document utilization review determinations accurately and timely.

Skills

Clinical judgment

Organizational skills

Oral communication

Problem-solving

Proficiency with MS Office

Education

Master's in psychology, counseling, or social work

Current, active clinical licensure

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?

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.

We are looking for someone with strong clinical judgment, who can build trusting relationships with members and partners, and effectively manage a high‑volume workload while meeting timelines. A collaborative mindset, accountability, curiosity, and comfort with technology will help you succeed on this team. This is a remote position based in Oregon and travel 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. Our talented remote workforce spans the country and plays a vital role in our success. We offer a remote work option with a stipend to enhance your workspace.

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

Required Qualifications

• Current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., RN or 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 OR Bachelor’s degree in nursing and licensed by the State of Oregon
• 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.

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

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 appropriateProvide 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
• 100% Remote (Oregon)
• 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 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; 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.