Remote Behavioral Health Utilization Reviewer

Comagine Health; Oregon (WI); Hybrid; USD 75,000 - 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"

Paid parental leave

Job summary

Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene and surrounding areas. You will review clinical documentation to determine medical necessity and coordinate assessments via EMR systems, ensuring timely decisions and high-quality care.

The role requires licensure, 3 years of direct patient care in behavioral health, and familiarity with utilization review.

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.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness for requested services.
• Perform initial and continued stay reviews using standardized, evidence-based criteria.
• Apply clinical review criteria, policies, and guidelines to determine medical necessity.
• Document utilization review determinations accurately and timely 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 SME support 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.

Skills

Clinical licensure

Clinical experience

Job description

Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene and surrounding areas. You will review clinical documentation to determine medical necessity and coordinate assessments via EMR systems, ensuring timely decisions and high-quality care.

The role requires licensure, 3 years of direct patient care in behavioral health, and familiarity with utilization review.