Clinical Reviewer - LCSW, LPC, LCPC - Salem, Oregon

COMAGINE HEALTH• OR, US, OR

61d•$75,000 - $90,000•Remote

About The Position

This is a remote position based in Salem, Oregon or surrounding areas and daily travel is required in the Salem, Oregon and surrounding areas. The role involves reviewing clinical documentation to determine medical necessity and appropriateness of services, completing functional needs assessments, and supporting service coordination to connect individuals with in-home and community-based care. Responsibilities include managing referrals, follow-ups, reviews, and assessments within an electronic medical record system, applying evidence-based criteria to utilization management reviews, documenting clinical determinations, providing subject matter expertise, and supporting quality activities and audits. The ideal candidate demonstrates strong clinical judgment, builds trusting relationships, effectively manages a high-volume workload, possesses a collaborative mindset, accountability, curiosity, and comfort with technology.

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
Candidates must 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
Proficiency with MS Office Suite and familiarity with database software

Responsibilities

Review clinical documentation to substantiate medical necessity and appropriateness for requested services
Perform initial and continued stay reviews using standardized, evidence-based criteria to ensure services align with individualized behavioral health needs
Apply clinical review criteria, organizational policies, guidelines, and screening tools to determine medical necessity of healthcare services
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