Behavioral Health Case Manager, Clinical Reviewer

This is a fully remote position, open to applicants in Oregon.

📋 Description

• Evaluate clinical documentation to assess the medical necessity and appropriateness of requested services.

• Conduct functional needs assessments to determine the impact of mental health symptoms on daily living activities.

• Facilitate service coordination to connect children, youth, and adults with in-home and community-based care.

• Oversee referrals, follow-ups, reviews, and assessments within an electronic medical record system.

• Execute initial and ongoing stay reviews utilizing standardized, evidence-based criteria.

• Implement clinical review standards, organizational policies, guidelines, and screening tools.

• Accurately and promptly document utilization review findings in designated systems.

• Consult with physician or practitioner reviewers for cases that do not satisfy clinical review criteria.

• Refer cases to other clinicians as deemed appropriate.

• Offer clinical and utilization review expertise while addressing stakeholder inquiries or concerns.

• Assist in quality assurance activities, audits, and other program support tasks.

• Provide guidance or oversight to non-clinical staff engaged in support activities, as applicable.

• Travel to client locations throughout Oregon for in-person assessments when necessary.

• Carry out additional duties as assigned.

⛳️ Requirements

• QMHP or current, active, unrestricted clinical licensure as mandated by the Oregon contract (e.g., RN, LCSW, LPC, LCPC, LPA, PsyD, PhD).

• Master's degree in physical or occupational therapy OR Master's degree in psychology, counseling, or social work OR a Bachelor's degree in nursing with a license from the State of Oregon.

• Minimum of 3 years of clinical experience (direct patient care), preferably in behavioral health.

• Must be a resident of Oregon.

• Personal transportation and the ability to travel.

• Valid driver's license and proof of auto insurance.

• Reliable and secure internet connection.

• Must maintain eligibility for licensure as required by the assigned state contract.

• Experience with Medicaid is preferred.

• Familiarity with the Oregon behavioral health system of care is desired.

• 2 years of experience in utilization review or other medical management is preferred.

• 2 years of full-time experience in substance use disorder and/or behavioral health disorder is desired.

• Expertise in clinical documentation review, including the use of the Oregon Health Plan Prioritized List of Health Services and InterQual.

• Strong organizational skills and the ability to manage multiple tasks in a collaborative team environment.

• Excellent oral and written communication capabilities.

• Strong interpersonal and problem-solving abilities.

• Proficiency in MS Office Suite and familiarity with database software.

• Ability to apply clinical review criteria, policies, and guidelines to assess medical necessity.

• Capability to document utilization review determinations accurately and promptly within designated systems.

• Ability to provide clinical and utilization review expertise while addressing stakeholder inquiries or concerns.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Paid time off for vacation, illness, and volunteering.

• Retirement savings plan with employer contributions.

• Financial assistance for adoption.

• Paid parental leave.

• Annual stipend for workspace enhancements.

• Option for remote work.

• Company-issued equipment.