Clinical Case Manager, Supervisor

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

📋 Description

• Oversee the operational management of clinical personnel engaged in utilization review and specialty review processes.

• Train, mentor, and assist clinical reviewers to ensure precise evaluations concerning medical necessity, quality, and suitability of healthcare services.

• Execute prospective, concurrent, retrospective, and pre-authorization utilization reviews utilizing InterQual, organizational policies, and regulatory standards.

• Manage utilization management, care coordination, and/or case management functions.

• Ensure adherence to quality, compliance, timeliness, and contractual performance benchmarks.

• Act as a point of escalation for intricate clinical or operational issues.

• Relay significant matters to leadership.

• Facilitate quality management initiatives, audits, training programs, and continuous improvement efforts.

• Conduct onboarding, coaching, performance evaluations, and ongoing professional development for staff.

• Review and authorize timecards and operational documentation.

• Collaborate with leadership and clients regarding contractual obligations, operational workflows, and reporting tasks.

• Support organizational objectives and accreditation requirements.

⛳️ Requirements

• Current, active, and unrestricted Oregon LPC, LCSW, LMFT, or RN licensure (with Behavioral Health experience).

• Five years of direct clinical experience in patient care.

• One year of experience in utilization review or medical management.

• Excellent communication, problem-solving, organizational, and customer service abilities.

• Capacity to lead teams in a remote work setting.

• Graduate degree in social work, psychology, or a related behavioral health science field, or a bachelor’s degree in nursing licensed by the State of Oregon, accompanied by relevant training in behavioral health service delivery.

• Previous supervisory or team leadership experience is preferred.

• A Master's degree in Behavioral Health is preferred.

• Experience in managed care, healthcare consulting, or payer environments is preferred.

• Familiarity with InterQual is preferred.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• Paid time off for vacations, illnesses, and volunteer activities.

• Retirement savings plan with employer contributions.

• Financial assistance for adoption.

• Paid parental leave.

• Annual stipend for remote work expenses.

• Flexible remote work arrangements.

• Opportunities for professional development and growth.