Clinical Reviewer

🕒 Yesterday

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $75k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Comagine Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1973

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

Comagine Health is a national nonprofit health care consulting organization that partners with providers, payers, public agencies, community organizations and consumers to improve health care quality, equity, and outcomes. It offers systemwide quality improvement, care management, data solutions, research and evaluation, and COVID-19 response services, using health information exchange and health IT to inform public health surveillance and program design. Comagine focuses on supporting community health, behavioral health, and patient-centered initiatives through technical assistance, evaluation, and collaborative systems-level work.

📋 Description

• 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 • Respond to stakeholder questions or concerns • Support quality assurance activities, audits, and other program support • Provide guidance or oversight to non-clinical staff performing support activities, as appropriate • Manage referrals, follow-ups, reviews, and assessments within an electronic medical record system • Complete functional needs assessments evaluating how mental health symptoms impact daily living • Support service coordination connecting children, youth, and adults to in-home and community-based care • Travel for in-person assessments as needed across the assigned region • Perform other duties as assigned

🎯 Requirements

• Current, active, unrestricted clinical licensure as required by the Oregon contract, such as LCSW, LPC, or LCPC • 3 years of clinical (direct patient care) experience; behavioral health preferred • Candidates must reside in Oregon • Personal transportation and ability to travel • Valid Driver License and Proof of Auto Insurance are required • Reliable, secure internet connection • Must maintain licensure eligibility for the assigned state contract • Experience with Medicaid may be beneficial • Knowledge of the Oregon behavioral health system of care may be beneficial • 2 years of utilization review or other medical management experience may be beneficial • 2 years of full-time substance use disorder and/or behavioral health disorder experience may be beneficial • Clinical documentation review expertise, including 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 • Ability to provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns

🏖️ Benefits

• 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 • Annual stipend to enhance the workspace • Remote work support • Work-life balance • Reasonable accommodations for individuals with disabilities