Remote Behavioral Health Utilization Review Clinician

Comagine.org; Oregon; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off for vacation, illness, &

Retirement savings plan with employer

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health is seeking a remote clinical reviewer to support behavioral health services across Oregon. You will evaluate documentation for medical necessity, conduct functional needs assessments, and coordinate home and community-based care.

You will manage referrals, reviews, and assessments in an electronic medical record system, apply evidence-based criteria, and document determinations with accuracy.

Qualifications

• Current, active, unrestricted clinical licensure per Oregon contract (e.g., LCSW, LPC, LCPC)
• 3 years of direct clinical patient care experience; behavioral health preferred
• Must reside in Oregon, have transport, and be able to travel; valid DL and insurance

Responsibilities

• Review clinical documents to substantiate medical necessity and service appropriateness
• Perform initial and continued stay reviews using evidence-based criteria
• Apply criteria, policies, guidelines to determine medical necessity
• Document utilization review determinations 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

Multitasking

Communication skills

Team collaboration

MS Office

System navigation

Education

Active clinical licensure (Oregon)

Tools

InterQual

Oregon Health Plan Priority List

Job description

Comagine Health is seeking a remote clinical reviewer to support behavioral health services across Oregon. You will evaluate documentation for medical necessity, conduct functional needs assessments, and coordinate home and community-based care.

You will manage referrals, reviews, and assessments in an electronic medical record system, apply evidence-based criteria, and document determinations with accuracy.