Clinical Reviewer-Children's Behavioral Health

Organization/Company Name: 
Comagine Health
Position Description: 

Together with our partners, Comagine Health works to improve health and create a better health care system so that people and communities will flourish.

We offer a competitive pay and benefits package plus employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!

This position helps children, and youth in Oregon’s Child Welfare system to live in the least restrictive setting possible appropriate to meet their needs.

This position supports adults, children, and youth with severe and persistent mental illness (SPMI), as well as those involved in the child welfare system to live in the least restrictive setting possible by ensuring desired and necessary supports and services are in place.

The Clinical Reviewer – Children’s Behavioral Health works with a team to support two contracts. In the first contract, the Clinical Reviewer – Children’s Behavioral Health is responsible for completing an independent assessment to determine a placement recommendation for children and young adults whom Child Welfare is referring to Qualified Residential Treatment Program (QRTP). This individual completes a Child and Adolescent Needs and Strengths assessment (CANS) with the child or young adult, reviews clinical documentation and factors in the Family and Permanency Team’s preference when determining if a QRTP is the least restrictive and most appropriate placement for the child or young adult.
In the second contract, the Clinical Reviewer – Children’s Behavioral Health will be reviewing inpatient psychiatric records for individuals with SPMI to determine if a warm handoff was provided by the hospital to assist in transitioning the individual to outpatient services when discharging from the hospital.

Please Note: Currently CANS are being completed via telehealth, but when COVID restrictions lift, the CANS will be completed in-person with the child or young adult and involve travel. Additionally, a successful candidate may reside anywhere in Oregon with preference for someone living in Central or Southern Oregon.

What you’ll be doing for us:

Conducts initial, annual, and as needed face-to-face assessments to create and maintain a tailored PCSP, utilizing LOCUS, the LSI, or CANS, and review of records

Provides support to individuals (and authorized representatives and supports) regarding the assessment process, and patient-centered service planning, service coordination, and transition planning, as appropriate

Assists in eligibility determinations for specific programs, as defined in contract

Works closely with individuals, providers, facilities, and social service and community organizations to assist individuals in accessing appropriate care

Ensures care is being delivered as described in the PCSP, working with providers and individuals to correct services or adjust the PCSP as needed.

Performs utilization management and utilization review, including prior authorizations for services and concurrent reviews for specific contracted services

Applies clinical review criteria, guidelines, and screens to determine the medical necessity of health care services

Consults with physicians or practitioner consultants when reviews fail clinical review criteria, guidelines, and screens

Follow all determinations, appeals and hearings policies, processes, and contract requirements

Position Type: 
Full Time
Required Qualifications and Experience: 

What would make you a strong fit for our role:

Demonstrated ability to conduct a behavioral health assessment including the identification of precipitating events, including health and safety risks to self or others

Competent in gathering histories of mental and physical health, substance use, and criminal justice system

Ability to conduct a mental status examination

Competent in providing DSM 5 diagnoses

Proficient in developing treatment plans and safety plans

Oregon Medicaid knowledge, and knowledge of Oregon Health Plan’s Prioritized List of Health Services preferred

Competencies:

Can work in unpredictable environments

Is a settling influence in a crisis

Genuinely cares about people

Is sympathetic to the plight of others

Utilizes active stress management/coping strategies

Demonstrates empathy

Builds rapport well

Is a good listener

Is easy to approach and talk to

Required Education and / or Certifications: 

 

MA/MS in social work, psychology, or other behavioral health science field; or

BS/MS in nursing and actively licensed by the State of Oregon (with relevant training in behavioral health service delivery)

Qualified Mental Health Professional (QMHP), required

A minimum of 2 years’ experience working with individuals with severe and persistent mental illness (SPMI), or children and young adults involved in the Children’s System of Care required

Experience with utilization review (or other medical management experience) preferred

Behavioral health clinical setting experience preferred

Address: 
Where Will Work Be Performed?: 
To Be Determined