Note: The job is a remote job and is open to candidates in USA. 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. In this role, you will review clinical documentation, perform functional needs assessments, and support service coordination for individuals in need of behavioral health services.
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
Skills
- 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
- 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
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.
- An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
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