Clinical Reviewer

Behavioral Health Services ReviewerAre you passionate about improving access to behavioral health services in the community? Do you enjoy using your clinical expertise to evaluate needs, support care decisions, and help individuals receive the right services at the right time?In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms impact daily living, and support service coordination that connects children, youth, and adults to in-home and community-based care. You will manage referrals, follow-ups, reviews, and assessments within an electronic medical record system; apply evidence-based criteria to utilization management reviews; document clinical determinations; provide subject matter expertise to stakeholders; support quality activities and audits; and travel for in-person assessments as needed across your assigned region.If you are someone who demonstrates strong clinical judgment, builds trusting relationships with members and partners, and effectively manages a high-volume workload while meeting timelines, we encourage you to apply. If you bring a collaborative mindset, accountability in your work, curiosity to ask questions and learn, and comfort using technology to navigate systems and documentation, you will be well-positioned for success on this team. This is a remote position based in Oregon and travel is required.Why Comagine Health?Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:Medical, dental and vision insurancePaid time off for vacation, illness, and volunteeringRetirement savings plan with employer contributionAdoption financial assistancePaid parental leave.And much more!You Have (Required Qualifications)Current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., RN or behavioral health licensure such as LCSW, LPC, LCPC, LPA, PsyD, PhD)Master's in physical or occupational therapy OR Master's in psychology, counseling, or social work OR Bachelor's degree in nursing and licensed by the State of Oregon3 years of clinical (direct patient care) experience; behavioral health preferredCandidates must reside in Oregon, have personal transportation, and ability to travel. Valid Driver License and Proof of Auto Insurance are required.You May Have (Desired Qualifications)Experience with MedicaidKnowledge of the Oregon behavioral health system of care2 years of utilization review or other medical management experience2 years of full-time substance use disorder and/or behavioral health disorder experienceYou Bring (Competencies)Clinical documentation review expertise, including use of the Oregon Health Plan Prioritized List of Health Services and InterQualStrong organizational skills and ability to manage multiple tasks in a team environmentExcellent oral and written communication skillsStrong interpersonal and problem-solving skillsProficiency with MS Office Suite and familiarity with database softwareAbility to apply clinical review criteria, policies, and guidelines to determine medical necessityAbility to document utilization review determinations accurately and timely in designated systemsCapability to provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concernsIn this Role, You WillReview clinical documentation to substantiate medical necessity and appropriateness for requested servicesPerform initial and continued stay reviews using standardized, evidence-based criteria to ensure services align with individualized behavioral health needsApply clinical review criteria, organizational policies, guidelines, and screening tools to determine medical necessity of healthcare servicesDocument utilization review determinations accurately and timely in designated systemsConsult with physician or practitioner reviewers when cases do not meet clinical review criteriaRefer cases to other clinicians when appropriateProvide clinical and utilization review subject matter expertise and respond to stakeholder questions or concernsSupport quality assurance activities, audits, and other program support as assignedProvide guidance or oversight to non-clinical staff performing support activities, as appropriatePerform other duties as assignedWork EnvironmentFull-Time100% Remote (Oregon)Travel requiredReliable, secure internet connection requiredMust maintain licensure eligibility for assigned state contractEqual Opportunity Employer Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.Physical Requirements & Work EnvironmentThis position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively.Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver's license and meet the organization's driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events.Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.