Behavioral Health Clinical Reviewer

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.

Are you passionate about improving access to behavioral health services in the community? Do you enjoy using your clinical expertise to evaluate needs, support care decisions, and help individuals receive the right services at the right time? In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms impact daily living, and support service coordination that connects children, youth, and adults to in-home and community-based care. You will 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; and travel for in-person assessments as needed across your assigned region. If you are someone who demonstrates strong clinical judgment, builds trusting relationships with members and partners, and effectively manages a high-volume workload while meeting timelines, we encourage you to apply. If you bring a collaborative mindset, accountability in your work, curiosity to ask questions and learn, and comfort using technology to navigate systems and documentation, you will be well-positioned for success on this team. This is a remote position based in Oregon and travel is required.

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