Remote Behavioral Health Utilization Reviewer (Oregon)

Comagine.org; Oregon; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental & vision

Paid time off

Retirement plan

Adoption assistance

Paid parental leave

Job summary

Comagine Health seeks a qualified clinician to review documentation for medical necessity and appropriateness of behavioral health services. You will perform initial/continued stay reviews, apply criteria, and document determinations within the EMR system while coordinating care across in-home and community-based settings.

Qualified candidates hold active Oregon licensure (LCSW/LPC/LCPC) and have 3+ years of direct clinical experience, with willingness to travel within Oregon.

Qualifications

• Active clinical licensure as required by the Oregon contract (LCSW, LPC, LCPC)
• Minimum 3 years of direct clinical experience; behavioral health preferred
• Residence in Oregon with ability to travel; valid driver license and auto insurance

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness
• Perform initial and continued stay reviews using evidence-based criteria
• Apply clinical review criteria and guidelines to determine medical necessity
• Document utilization review determinations accurately in designated systems
• Consult with physicians when cases don’t meet criteria
• Refer cases to other clinicians as appropriate
• Support quality assurance activities and audits
• Provide guidance to non-clinical staff as needed
• Perform other duties as assigned

Skills

Clinical documentation

Organizational skills

Communication skills

Interpersonal skills

Problem-solving

MS Office

Database familiarity

Utilization review criteria

Education

Active clinical licensure (LCSW/LPC/LCPC) in Oregon

Tools

InterQual

OHP Prioritized List

Microsoft Office

EMR systems

Job description

Comagine Health seeks a qualified clinician to review documentation for medical necessity and appropriateness of behavioral health services. You will perform initial/continued stay reviews, apply criteria, and document determinations within the EMR system while coordinating care across in-home and community-based settings.

Qualified candidates hold active Oregon licensure (LCSW/LPC/LCPC) and have 3+ years of direct clinical experience, with willingness to travel within Oregon.