Clinical Reviewer

Comagine Health; Oregon; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off

Retirement savings plan with employer

Paid parental leave

Workspace stipend

Job summary

Comagine Health in Oregon seeks a Clinical Reviewer to evaluate medical necessity and appropriateness of behavioral health services. You will review clinical documentation, perform utilization reviews, and document determinations in an electronic medical record system while supporting care coordination across children, youth, and adults.

This remote, Oregon-based role requires active licensure (e.g., LCSW, LPC, LCPC), 3 years of direct clinical experience, and willingness to travel in the Eugene

Qualifications

• Current, active, unrestricted clinical licensure as required by the Oregon contract.
• 3 years of clinical (direct patient care) experience; behavioral health preferred.
• Residence in Oregon and ability to travel.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness.
• Perform initial and continued stay reviews using evidence-based criteria.
• Document utilization review determinations accurately in designated systems.
• Consult with physician/practitioner reviewers when cases do not meet criteria.
• Provide SME support and respond to stakeholder questions or concerns.
• Support quality assurance activities and audits.

Skills

Clinical judgment

Communication

Organizational skills

High-volume work management

Education

LCSW

LPC

LCPC

Tools

EMR systems

MS Office

Database software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Clinical Reviewer

2 days ago Requisition ID: 1130

Salary Range: $75,000.00 To $90,000.00 Annually

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.

If you are someone who demonstrates strong clinical judgment, 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 is a remote position based in Oregon and travel is required in the Eugene, Oregon and surrounding areas.

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 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. 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
• Paid parental leave.
• And much more!

You Have (Required Qualifications)

• Current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., behavioral health licensure such as LCSW, LPC, LCPC)
• 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
• 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
• Full-Time
• 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, 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.