Remote Utilization Review Clinician (LCSW/LPC/LCPC)

Comagine.org; Oregon; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off for vacation and illness

Retirement savings plan with employer/

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health invites applications for a remote utilization review clinician based in Salem, Oregon, or surrounding areas. The role requires evaluating medical necessity, performing functional needs assessments, and coordinating in-home and community-based behavioral health services across the assigned region.

You will work with an electronic medical record, apply evidence-based criteria, document determinations, and support quality activities.

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, 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.

Skills

Clinical documentation review

Utilization review

InterQual criteria

Communication skills

Time management

Team collaboration

Tools

MS Office Suite

EMR systems

Job description

Comagine Health invites applications for a remote utilization review clinician based in Salem, Oregon, or surrounding areas. The role requires evaluating medical necessity, performing functional needs assessments, and coordinating in-home and community-based behavioral health services across the assigned region.

You will work with an electronic medical record, apply evidence-based criteria, document determinations, and support quality activities.