Remote Behavioral Health Utilization Reviewer (Oregon)

COMAGINE HEALTH; Portland (OR); On-site; USD 85,000 - 110,000; 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 evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR.

You will travel for in-person assessments as needed within the assigned region; Oregon licensure is required, with travel to Eugene and surrounding areas as needed. This is a full-time, remote position based in Oregon.

Qualifications

• Active clinical licensure in Oregon (LCSW/LPC/LCPC) and ability to practice.
• Minimum 3 years of direct clinical care experience, behavioral health preferred.
• Experience with utilization review processes and criteria.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness of services.
• Perform initial and continued stay reviews using standardized, evidence-based criteria.
• Document utilization review determinations accurately in designated systems.
• Consult with physician reviewers when cases do not meet clinical review criteria.
• Refer cases to other clinicians when appropriate.
• Support quality assurance activities, audits, and other program support as assigned.

Skills

Clinical documentation review

Utilization review

InterQual criteria

MS Office proficiency

Education

Licensed Behavioral Health Clinician (LCSW/LPC/LCPC)

Job description

Comagine Health is seeking a remote clinical reviewer to evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR.

You will travel for in-person assessments as needed within the assigned region; Oregon licensure is required, with travel to Eugene and surrounding areas as needed. This is a full-time, remote position based in Oregon.