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Behavioral Health Clinical Reviewer, Portland, OR


Organization: Comagine Health
Category: Behavioral Health Professional
Location: Portland, OR
Date Job Posted: February 25, 2020
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Behavioral Health Clinical Reviewer

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 Behavioral Health Clinical Reviewer, you would:

  • Apply clinical review criteria, guidelines, and screens to determine the medical necessity of health care services.
  • Consult with physicians or practitioner consultants when reviews fail clinical review criteria, guidelines, and screens.
  • Follow all determinations, appeals and hearings policies, processes and contract requirements.
  • Review and provide continued stay authorizations for multiple levels of care.

Role qualifications include:

  • 3+ years of clinical work experience in behavioral health.
  • Prior medical management experience preferred.
  • MA / MS in social work, psychology, or another behavioral health field. We would consider a BA/BS in Nursing with an RN license and relevant behavioral health experience.
  • Current, active, unrestricted Licensed Clinical Social worker (LCSW), Licensed Professional Counselor (LPC), Licensed Psychologist, or Licensed Marriage and Family Therapist (LMFT) in Oregon preferred but not required
  • Familiarity with Oregon Medicaid, including Oregon Health Plan’s Prioritized List of Health Services, preferred but not required

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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