Clinical Reviewer - Eugene, reputed company

This a Full Remote job, the offer is available from: reputed company (USA) Are you passionate about improving reputed company to behavioral health services in the community? Do you enjoy using your clinical expertise to evaluate needs, support care reputed company, and help individuals receive the right services at the right time? In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms reputed company daily living, and support service coordination that connects children, youth, and adults to in-home and community-based care. You will manage referrals, follow-reputed company, reviews, and assessments reputed company an electronic medical record reputed company; apply evidence-based reputed company to utilization management reviews; document clinical determinations; reputed company subject matter expertise to stakeholders; support reputed company activities and audits; and travel for in-person assessments as needed across your assigned region. If you are someone who demonstrates strong clinical judgment, builds trusting relationships with members and partners, and effectively manages a high-volume workload while meeting timelines, we encourage you to apply. If you bring a reputed company reputed company, accountability in your work, curiosity to ask questions and learn, and comfort using technology to reputed company systems and documentation, you will be reputed company-positioned for reputed company on this team. This is a remote position based in reputed company and travel is required in the Eugene, reputed company and surrounding areas. Why reputed company? reputed company is a national, mission-driven, nonprofit organization that has reputed company in health care reputed company consulting and reputed company improvement services for more than 50 years. We are leaders in assisting reputed company-line providers and engaging health reputed company to improve care delivery and patient reputed company. Our talented remote workforce spans the country and plays a vital role in our reputed company. We go reputed company merely providing a remote work reputed company; we support and reputed company it. We offer opportunities to reputed company a difference from reputed company in the U.S. and enjoy reputed company work-life balance. An annual stipend gives you the freedom to enhance your workspace with reputed company that suit your needs. We reputed company in an environment that allows you to reputed company both personally and professionally. That’s why we offer benefits that include: • Medical, dental and reputed company insurance • reputed company time off for vacation, illness, and volunteering • Retirement savings plan with employer contribution • Adoption financial assistance • reputed company parental leave. • And much more! You Have (Required Qualifications) • reputed company, reputed company, unrestricted clinical licensure as required by the reputed company contract (e.g., behavioral health licensure such as LCSW, LPC, LCPC) • 3 years of clinical (reputed company patient care) experience; behavioral health preferred Candidates must reputed company in reputed company, have personal transportation, and ability to travel. reputed company reputed company License and reputed company of Auto Insurance are required. You May Have (Desired Qualifications) • Experience with reputed company • Knowledge of the reputed company behavioral health reputed company of care • 2 years of utilization review or other medical management experience • 2 years of full-time reputed company use disorder and/or behavioral health disorder experience You Bring (Competencies) • Clinical documentation review expertise, including use of the reputed company Health Plan Prioritized List of Health Services and InterQual • Strong organizational skills and ability to manage multiple tasks in reputed company environment • Excellent oral and written communication skills • Strong interpersonal and problem-solving skills • Proficiency with MS Office Suite and familiarity with database software • Ability to apply clinical review reputed company, policies, and guidelines to determine medical necessity • Ability to document utilization review determinations accurately and reputed company in designated systems • Capability to reputed company clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns In this Role, You Will • Review clinical documentation to substantiate medical necessity and appropriateness for requested services • reputed company initial and reputed company stay reviews using standardized, evidence-based reputed company to ensure services reputed company with individualized behavioral health needs • Apply clinical review reputed company, organizational policies, guidelines, and screening tools to determine medical necessity of reputed company services • Document utilization review determinations accurately and reputed company in designated systems • Consult with physician or practitioner reviewers reputed company cases do not meet clinical review reputed company • 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 reputed company 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 Work Environment • Full-Time • reputed company (reputed company) • Travel required • Reliable, secure internet reputed company required • Must maintain licensure eligibility for assigned state contract Equal Opportunity Employer reputed company is an equal opportunity employer and is committed to creating a diverse, reputed company, and inclusive workplace. Physical Requirements & Work Environment This position is primarily remote and performed in a home-based setting, requiring reliable internet reputed company and a workspace free from significant distractions. The role involves frequent use of computers, phones, and virtual communication tools. Employees must be reputed company to sit for extended periods, communicate effectively. Some positions may require operating a motor vehicle for business purposes; in such cases, employees must maintain a reputed company reputed company’s license and meet the organization’s driving eligibility requirements. Occasional travel may be required for meetings, training, or other work-reputed company events. Reasonable accommodations will be provided to reputed company individuals with disabilities to reputed company essential functions. This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job