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Manager, Utilization Review, Portland, OR


Organization: Comagine Health
Category: Manager
Location: Portland, OR
Date Job Posted: February 25, 2020
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Manager, Utilization Review

At Comagine Health, we work to improve health and create a better health care system so that people and communities will flourish. Our care management services result in better clinical outcomes, higher patient satisfaction, and increased cost savings. Our approach is customized for each client using evidence-based criteria and medicine, data analysis, and deep clinical and technical proficiency.

We’re proud to have been selected by the Oregon Health Authority (OHA) to provide statewide eligibility determination, service coordination, medical appropriateness reviews, and transition planning for individuals diagnosed with serious and persistent mental illness (SPMI). In partnership with OHA, Comagine Health is committed to ensuring that individuals with SPMI receive the right care in the right setting based their specific needs. We welcome you to join us in our mission to improve population health and eliminate health disparities for vulnerable populations.

We’ll assess the medical necessity and quality of healthcare services provided to adults with SPMI. These reviews will be conducted for Medicaid and non-Medicaid eligible recipients in a variety of settings that include Secure Residential Treatment Facilities (SRTF), Residential Treatment Homes (RTH), Residential Treatment Facilities (RTF), Behavioral Health Personal Care Attendant Program (State Plan Personal Care or SPPC), recipients with chronic mental illness in Oregon State Hospital (OSH), Transition Age Youth in residential treatment homes, and Crisis Respite. As our Manager, Utilization Review, you would:

  • Supervise Behavioral Health Clinical Reviewers and Program Coordinators.
  • Ensure high-quality, timely delivery of all utilization review deliverables.
  • Develop, review, and maintain policies and procedures to comply with all contractual requirements; oversee quality assurance program.
  • Provide clinical and/or utilization review subject matter expertise, and respond to recipient and providers requests.
  • May perform utilization reviews, as workload and other factors indicate.

Role qualifications include:

  • 5+ years of relevant work experience.
  • Prior utilization review plus supervisory and/or management experience.
  • Familiarity with Oregon Medicaid, including Oregon Health Plan’s Prioritized List of Health Services.
  • MA / MS or PhD in social work, psychology, or another behavioral health field.
  • Current, active, unrestricted Licensed Clinical Social worker (LCSW), Licensed Professional Counselor (LPC), Licensed Psychologist, or Licensed Marriage and Family Therapist (LMFT) in Oregon preferred.

To learn more and apply, visit https://comaginehealthcareers.silkroad.com/qualisext/EmploymentListings.html

Comagine Health is an Affirmative Action / Equal Employment Opportunity Employer that embraces and practices diversity, reflecting the communities we serve. We encourage minorities, Protected Veterans, and individuals with disabilities to apply.


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