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 insurance Paid time off for vacation, illness, and volunteering Retirement savings plan with employer contribution Adoption financial assistance Paid 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 Oregon 3 years of clinical (direct patient care) experience; behavioral health preferred Candidates 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 Medicaid Knowledge of the Oregon behavioral health system of care 2 years of utilization review or other medical management experience 2 years of full-time substance use disorder and/or behavioral health disorder experience You Bring (Competencies) Clinical documentation review expertise, including use of the Oregon Health Plan Prioritized List of Health Services and InterQual Strong organizational skills and ability to manage multiple tasks in a team environment Excellent oral and written communication skills Strong interpersonal and problem-solving skills Proficiency with MS Office Suite and familiarity with database software Ability to apply clinical review criteria, policies, and guidelines to determine medical necessity Ability to document utilization review determinations accurately and timely in designated systems Capability to provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns