Remote Behavioral Health Utilization Reviewer

Comagine Health; Oregon; Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off

Retirement savings plan with employer

Paid parental leave

Workspace stipend

Job summary

Comagine Health in Oregon seeks a Clinical Reviewer to evaluate medical necessity and appropriateness of behavioral health services. You will review clinical documentation, perform utilization reviews, and document determinations in an electronic medical record system while supporting care coordination across children, youth, and adults.

This remote, Oregon-based role requires active licensure (e.g., LCSW, LPC, LCPC), 3 years of direct clinical experience, and willingness to travel in the Eugene

Qualifications

• Current, active, unrestricted clinical licensure as required by the Oregon contract.
• 3 years of clinical (direct patient care) experience; behavioral health preferred.
• Residence in Oregon and ability to travel.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness.
• Perform initial and continued stay reviews using evidence-based criteria.
• Document utilization review determinations accurately in designated systems.
• Consult with physician/practitioner reviewers when cases do not meet criteria.
• Provide SME support and respond to stakeholder questions or concerns.
• Support quality assurance activities and audits.

Skills

Clinical judgment

Communication

Organizational skills

High-volume work management

Education

LCSW

LPC

LCPC

Tools

EMR systems

MS Office

Database software

Job description

Comagine Health in Oregon seeks a Clinical Reviewer to evaluate medical necessity and appropriateness of behavioral health services. You will review clinical documentation, perform utilization reviews, and document determinations in an electronic medical record system while supporting care coordination across children, youth, and adults.

This remote, Oregon-based role requires active licensure (e.g., LCSW, LPC, LCPC), 3 years of direct clinical experience, and willingness to travel in the Eugene