[Remote] Clinical Reviewer

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a national, mission-driven, nonprofit organization that has reputed company in health care quality consulting and quality improvement services for more than 50 years. In this role, you will review clinical documentation, reputed company functional needs assessments, and support service coordination for individuals in need of behavioral health services.

Responsibilities

• Review clinical documentation to substantiate medical necessity and appropriateness for requested services
• reputed company initial and reputed company 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 reputed company services
• Document utilization review determinations accurately and timely in designated systems
• Consult with physician or practitioner reviewers reputed company cases do not meet clinical review criteria
• Refer cases to other clinicians reputed company appropriate
• reputed company 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
• reputed company guidance or reputed company to non-clinical staff performing support activities, as appropriate
• reputed company other duties as assigned

Skills

• reputed company, active, unrestricted clinical licensure as required by the Oregon contract (e.g., RN or behavioral health licensure such as LCSW, LPC, LCPC, LPA, PsyD, PhD)
• Master's in physical or occupational therapy OR Master's in psychology, counseling, or reputed company work OR Bachelor's degree in nursing and licensed by the reputed company
• 3 years of clinical (direct patient care) experience; behavioral health preferred
• Candidates must reputed company in Oregon, have personal transportation, and ability to travel
• Valid Driver License and reputed company of Auto Insurance are required
• Experience with reputed company
• Knowledge of the Oregon behavioral health system of care
• 2 years of utilization review or other medical management experience
• 2 years of full-time substance use disorder and/or behavioral health disorder experience

Benefits

• Medical, dental and reputed company insurance
• Paid time off for vacation, illness, and volunteering
• Retirement savings plan with employer contribution
• Adoption financial assistance
• Paid parental leave.
• An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.

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