Clinical Reviewer - Eugene, Oregon

About the role

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.

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

Responsibilities

• Review clinical documentation to determine medical necessity and appropriateness of services
• Complete functional needs assessments that evaluate how mental health symptoms impact daily living
• Support service coordination that connects 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 your assigned region

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
• Personal transportation and ability to travel
• Valid Driver License and Proof of Auto Insurance

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

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

Work Environment

• Full-Time
• 100% Remote (Oregon)
• Travel required
• Reliable, secure internet connection required
• Must maintain licensure eligibility for assigned state contract

Physical Requirements & Work Environment

This position is primarily remote and performed in a home-based setting, requiring reliable internet access and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be able to sit for extended periods, communicate effectively. Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a valid driver’s license and meet the organization’s driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-related events. Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions.