Remote Behavioral Health Utilization Reviewer

Comagine Health; Oregon (WI); On-site; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

PTO

Retirement Plan

Parental Leave

Job summary

Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel to Salem and surrounding areas. Review clinical documentation to determine medical necessity and coordinate in-home and community-based care for diverse populations.

The position emphasizes utilization review, documentation, and collaboration with stakeholders while supporting quality initiatives.

Qualifications

• Current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., 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, organizational policies, guidelines, and screening tools to determine medical necessity
• 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

Skills

Clinical licensure

Clinical experience

Job description

Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel to Salem and surrounding areas. Review clinical documentation to determine medical necessity and coordinate in-home and community-based care for diverse populations.

The position emphasizes utilization review, documentation, and collaboration with stakeholders while supporting quality initiatives.