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Blue Cross Rn Remote Jobs in Oregon (NOW HIRING)

Mvphealthcare

Sub-Acute RN UM Reviewer - Medicare

OR · Remote

$69.38K - $92.28K/yr

Remote Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith ...

Ascension

Director of Nursing Practice

$129.94K - $183.45K/yr

Remote with 25% Travel Department: Research and EBP Schedule: Full-Time, Days Salary range: $129 ... Registered Nurse obtained prior to hire date or job transfer date required. * BLS Provider obtained ...

Performant

Medical Review Nurse II - SNF/MDS

OR · On-site +1

Interface with and support the Medical Director and cross train in all clinical departments/areas ... remote setting. Required and Preferred Qualifications: * Active unrestricted RN license in good ...

Lumimeds

Healthcare Content Creator (LP/NP/RN/PA/MD)

OR · Remote

LP (Licensed Pharmacist), NP (Nurse Practitioner), RN (Registered Nurse), PA (Physician Assistant ... Fully remote, U.S.-based * Time commitment: ~4-10 hours/month, flexible scheduling around shoots ...

HealthEdge

Utilization Management QA RN

The UM QA RN is responsible for assisting and in organizing and facilitating strategic program ... Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt Work ...

ZoomCare

Psychiatric Nurse Practitioner

Portland, OR · On-site +1

$140K - $163K/yr

Remote Schedule (Must be located in Oregon) ESSENTIAL FUNCTIONS Reasonable accommodations may be ... Current Registered Nursing licensure in Oregon and Washington. * Master of Science in Nursing (MSN ...

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Blue Cross Rn Remote information

What are the key skills and qualifications needed to thrive as a Blue Cross RN Remote, and why are they important?

To excel as a Blue Cross RN Remote, you need an active RN license, clinical nursing experience (often in case management or utilization review), and strong assessment abilities. Familiarity with electronic medical record (EMR) systems, telehealth platforms, and case management software is typically required, along with certifications like CCM (Certified Case Manager) being advantageous. Exceptional communication, self-motivation, and organizational skills help nurses effectively support members and collaborate virtually with healthcare teams. These competencies ensure quality patient care, regulatory compliance, and efficient service delivery in a remote environment.

How does a remote Blue Cross RN typically communicate and coordinate care with interdisciplinary team members?

As a remote Blue Cross RN, effective communication with physicians, case managers, social workers, and other healthcare professionals is essential. Most coordination occurs via secure digital platforms, video calls, and phone conferences, allowing for timely updates on patient progress and care plans. Regular virtual meetings and documentation in shared electronic health records ensure seamless teamwork and continuity of care. Building strong digital communication skills and being proactive about follow-ups are key to success in this remote setting.

What is a Blue Cross RN Remote?

A Blue Cross RN Remote is a registered nurse who works remotely for Blue Cross Blue Shield, typically supporting members through telehealth, case management, care coordination, and health coaching. These nurses use phone, video calls, and digital platforms to assess patient needs, develop care plans, and provide education and support. Their role helps ensure that members receive high-quality care and guidance without needing in-person visits, making healthcare more accessible and convenient. Blue Cross RNs working remotely may also assist with pre-authorization, utilization management, or disease management programs.

What is the difference between Blue Cross Rn Remote vs Blue Cross Lpn Remote?

AspectBlue Cross Rn RemoteBlue Cross Lpn Remote
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote healthcare support, patient assessmentsRemote patient care, basic clinical tasks
Employer & Industry UsageHealth insurance companies, healthcare providersHealth insurance companies, healthcare providers
Common Search & ComparisonYesYes

Blue Cross Rn Remote and Blue Cross Lpn Remote roles both serve in remote healthcare settings within insurance companies and healthcare providers. The main difference lies in the required credentials: RNs need a registered nurse license, while LPNs require a practical nurse license. RNs typically handle more complex patient assessments, whereas LPNs focus on basic patient care tasks. Both roles are essential in remote healthcare support, but they differ in scope and qualification requirements.

What are popular job titles related to Blue Cross Rn Remote jobs in Oregon? For Blue Cross Rn Remote jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Blue Cross Rn Remote jobs in Oregon look for? The top searched job categories for Blue Cross Rn Remote jobs in Oregon are:
What cities in Oregon are hiring for Blue Cross Rn Remote jobs? Cities in Oregon with the most Blue Cross Rn Remote job openings:
Blue Cross Rn Remote jobs near you
Infographic showing various Blue Cross Rn Remote job openings in Oregon as of May 2026, with employment types broken down into 1% As Needed, 78% Full Time, 9% Part Time, and 12% Contract. Highlights an 19% Physical, and 81% Remote job distribution.
Director UM Management Nurse

Director UM Management Nurse

Millennium Physician Group

Remote

Full-time

Posted 16 days ago

Millennium Physician Group rating

6.2

Company rating: 6.2 out of 10

Based on 59 frontline employees who took The Breakroom Quiz

686th of 864 rated healthcare providers

Job description

Job Description Summary

The UM Nurse Lead is responsible for conducting and overseeing clinical utilization management activities to ensure medically appropriate, high-quality, and cost-effective care for members. This role collaborates with healthcare providers, members, and operational leadership to promote quality outcomes, optimize member benefits, and support effective resource utilization particularly for complex medical cases.
The UM Nurse Lead serves as a subject matter expert within the department, supports regulatory and accreditation readiness, and may lead intradepartmental initiatives and team activities.

How will you make an impact & Requirements

Clinical Utilization Management

  • Conduct prospective, concurrent, and retrospective reviews for:
    • Inpatient admissions
    • Continued stay reviews
    • Outpatient services
    • Surgical and diagnostic procedures
    • Out-of-network services
    • Appropriateness of treatment setting
  • Apply evidence-based guidelines (e.g., MCG, InterQual), CMS regulations, medical policies, and industry standards to determine medical necessity.
  • Accurately interpret and apply member eligibility, benefits, contracts, and managed care products.
  • Ensure compliance with regulatory and accreditation standards (e.g., NCQA, URAC, CMS).

Collaboration & Care Coordination

  • Collaborate with providers and members to promote quality outcomes and cost-effective care.
  • Work closely with Regional Medical Directors for:
    • Interpretation of complex cases
    • Medical necessity clarification
    • Non-certification determinations (does not independently issue denials when physician review is required).
  • Facilitate care transitions across the healthcare continuum.
  • Refer treatment plans to clinical reviewers and/or Medical Directors as required.

Appeals & Compliance

  • Participate in the review and coordination of appeals for services denied.
  • Ensure documentation is complete, accurate, and compliant with internal policies and regulatory standards.
  • Facilitate accreditation readiness by understanding and correctly applying accrediting and regulatory requirements.

Leadership & Oversight

  • Serve as a clinical resource to team members.
  • Provide guidance on medical policy interpretation and UM processes.
  • Participate in or lead intradepartmental teams, projects, and quality improvement initiatives.
  • Identify trends in utilization patterns and contribute to performance improvement strategies.
  • Support staff training and onboarding activities as needed.

Qualifications

  • Current, active, unrestricted RN license in applicable state(s) or U.S. territory.
  • Associate's Degree in Nursing required; Bachelor's degree preferred.
  • Minimum of 5 years of:
    • Acute care clinical experience, or
    • Case management, utilization management, or managed care experience,
    • Or any combination of education and experience providing equivalent background.
  • Prior managed care or health plan/MSO experience strongly preferred.
  • Participation in the American Association of Managed Care Nurses (AAMCN) preferred.

Required Knowledge & Skills

  • Strong knowledge of:
    • Medical management processes
    • Medical necessity review criteria (MCG, InterQual)
    • Member contracts and benefit interpretation
    • Managed care products
  • Understanding of Medicare/Medicaid regulations.
  • Strong clinical judgment within RN scope of practice.
  • Excellent oral, written, and interpersonal communication skills.
  • Strong analytical, problem-solving, and facilitation skills.
  • Proficiency with EMRs, review platforms, and Microsoft Office applications.
  • Ability to manage multiple priorities in a fast-paced or remote environment.

What Millennium Physician Group employees say

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