Clinical Reviewer - Portland, Oregon

COMAGINE HEALTH•Eugene, OR

1d•$75,000 - $90,000•Remote

About The Position

This role focuses on improving access to behavioral health services by evaluating clinical documentation, assessing functional needs, and supporting care coordination. The Clinical Reviewer will connect individuals with in-home and community-based care, manage referrals and assessments within an electronic medical record system, and apply evidence-based criteria for utilization management reviews. Responsibilities include documenting clinical determinations, providing subject matter expertise, supporting quality activities, and conducting in-person assessments as needed. The ideal candidate demonstrates strong clinical judgment, relationship-building skills, and the ability to manage a high-volume workload effectively. A collaborative mindset, accountability, curiosity, and technological proficiency are also valued.

Requirements

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
Reside in Oregon
Have personal transportation
Ability to travel
Valid Driver License and Proof of Auto Insurance are required.
Reliable, secure internet connection required
Must maintain licensure eligibility for assigned state contract

Nice To Haves

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
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

Responsibilities

Review clinical documentation to determine medical necessity and appropriateness of services.
Complete functional needs assessments to evaluate how mental health symptoms impact daily living.
Support service coordination to connect children, youth, and adults to in-home and community-based care.
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.
Travel for in-person assessments as needed across the assigned region.
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.
Consult with physician or practitioner 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.
Provide guidance or oversight to non-clinical staff performing support activities, as appropriate.
Perform other duties as assigned.