Clinical Case Manager, Supervisor
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Job Description
Clinical Review Supervisor leading behavioral health utilization reviews and clinical staff. Supporting healthcare quality, compliance, training, and operational performance for Comagine Health.
Responsibilities:
- Provide operational supervision of clinical staff conducting utilization review and specialty review activities
- Guide, train, and support clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services
- Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, organizational policies, and regulatory guidelines
- Supervise utilization management, care coordination, and/or case management activities
- Ensure quality, compliance, timeliness, and contractual performance standards are met
- Serve as an escalation point for complex clinical or operational concerns
- Communicate significant issues to leadership
- Support quality management initiatives, audits, training efforts, and continuous improvement activities
- Conduct onboarding, coaching, performance management, and ongoing staff development
- Review and approve timecards and operational documentation
- Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities
- Support organizational goals and accreditation standards
Requirements:
- Current, active, unrestricted Oregon LPC, LCSW, LMFT or RN (with Behavioral Health experience) licensure
- 5 years of direct patient care clinical experience
- 1 year of utilization review or medical management experience
- Strong communication, problem-solving, organizational, and customer service skills
- Ability to lead teams in a remote work environment
- Graduate degree in social work, psychology, or other behavioral health science field OR bachelor's degree in nursing and licensed by the State of Oregon, with relevant training in behavioral health service delivery
- Prior supervisory or team leadership experience preferred
- Master's degree in Behavioral Health preferred
- Experience working within managed care, healthcare consulting, or payer environments preferred
- InterQual experience preferred
Benefits:
- Medical, dental, and vision insurance
- Paid time off for vacation, illness, and volunteering
- Retirement savings plan with employer contribution
- Adoption financial assistance
- Paid parental leave
- Annual remote work stipend
- Flexible remote work
- Professional growth opportunities
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