Clinical Reviewer - Portland, Oregon

Comagine.org; Oregon; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental & vision

Paid time off

Retirement plan

Adoption assistance

Paid parental leave

Job summary

Comagine Health seeks a qualified clinician to review documentation for medical necessity and appropriateness of behavioral health services. You will perform initial/continued stay reviews, apply criteria, and document determinations within the EMR system while coordinating care across in-home and community-based settings.

Qualified candidates hold active Oregon licensure (LCSW/LPC/LCPC) and have 3+ years of direct clinical experience, with willingness to travel within Oregon.

Qualifications

• Active clinical licensure as required by the Oregon contract (LCSW, LPC, LCPC)
• Minimum 3 years of direct clinical experience; behavioral health preferred
• Residence in Oregon with ability to travel; valid driver license and auto insurance

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness
• Perform initial and continued stay reviews using evidence-based criteria
• Apply clinical review criteria and guidelines to determine medical necessity
• Document utilization review determinations accurately in designated systems
• Consult with physicians when cases don’t meet criteria
• Refer cases to other clinicians as appropriate
• Support quality assurance activities and audits
• Provide guidance to non-clinical staff as needed
• Perform other duties as assigned

Skills

Clinical documentation

Organizational skills

Communication skills

Interpersonal skills

Problem-solving

MS Office

Database familiarity

Utilization review criteria

Education

Active clinical licensure (LCSW/LPC/LCPC) in Oregon

Tools

InterQual

OHP Prioritized List

Microsoft Office

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?

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 throughout the Portland, 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
• Adoption financial assistance
• 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

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
• 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, 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.