Remote Behavioral Health Case Manager & Utilization Review

Comagine Health; Town of Murry (WI); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement plan

Adoption assistance

Parental leave

Job summary

Comagine Health is recruiting for Behavioral Health/Clinical Reviewer roles across Oregon. You will review clinical documentation for medical necessity, perform utilization reviews, and support care coordination for children through adults, with travel within the region as needed.

Roles require clinical licensure (or QMHP) and a relevant Master's degree, plus 3 years of direct patient care experience in behavioral health.

Qualifications

• QMHP OR active, unrestricted clinical licensure as required by Oregon contract
• Master's degree in psychology, counseling, or social work or related field
• 3 years of clinical (direct patient care) experience; behavioral health preferred

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness for requested services
• Perform initial and continued stay reviews using evidence-based criteria
• Apply clinical review criteria, policies, and guidelines to determine medical necessity
• Document utilization review determinations accurately in designated systems
• Consult with physician reviewers when cases do not meet criteria
• Refer cases to other clinicians when appropriate
• Provide clinical and utilization review subject matter expertise to stakeholders
• Support quality assurance activities and audits
• Provide guidance to non-clinical staff performing support activities
• Perform other duties as assigned

Skills

Clinical documentation review

Organizational skills

Communication skills

Interpersonal skills

Problem-solving

MS Office

Database knowledge

Utilization review knowledge

Education

QMHP OR active clinical licensure

Master's degree in psychology, counseling, social work, or related field

Tools

Electronic Medical Records (EMR)

InterQual criteria

MS Office Suite

Job description

Comagine Health is recruiting for Behavioral Health/Clinical Reviewer roles across Oregon. You will review clinical documentation for medical necessity, perform utilization reviews, and support care coordination for children through adults, with travel within the region as needed.

Roles require clinical licensure (or QMHP) and a relevant Master's degree, plus 3 years of direct patient care experience in behavioral health.