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Blue Cross Rn Remote Jobs in Portland, OR (NOW HIRING)

Clarvida

Psychiatric Registered Nurse Part Time

Camas, WA · Remote

$43 - $54/hr

Registered Nurse - Community Based Vancouver WA area part time 20 hours a week In this integral ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...

Formic

Automation Sales Manager

Portland, OR · Remote

Medical, dental, and vision insurance through Blue Cross Blue Shield and Unum, with 99% of employee ... A one-time allowance for fully remote and hybrid employees to support an at-home or on-the-road ...

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.

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 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.

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 are popular job titles related to Blue Cross Rn Remote jobs in Portland, OR? For Blue Cross Rn Remote jobs in Portland, OR, the most frequently searched job titles are:
What job categories do people searching Blue Cross Rn Remote jobs in Portland, OR look for? The top searched job categories for Blue Cross Rn Remote jobs in Portland, OR are:
Blue Cross Rn Remote jobs near you
Infographic showing various Blue Cross Rn Remote job openings in Portland, OR as of July 2026, with employment types broken down into 74% Full Time, 13% Part Time, and 13% Contract. Highlights an 100% Remote job distribution.
Registered Nurse / RN - Utilization Management I

Registered Nurse / RN - Utilization Management I

CareOregon

Portland, OR • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

CareOregon rating

8.3

Company rating: 8.3 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

121st of 298 rated insurance

Job description

Registered Nurse / RN - Utilization Management I
The Registered Nurse - Utilization Management I is responsible for supporting specific utilization management (UM) program functions within the Clinical Operations department. UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services (HRS). Together they support the healthcare needs of members, determine the best medically appropriate services, and apply clinical-based criteria for decision-making while managing medical expenses.
Estimated Hiring Range:
$102,330.00 - $125,070.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities
General Duties
  • Communicate with members and/or providers in a professional manner and in accordance with State and Federal requirements as needed to complete requests.
  • Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
  • Refer members to care coordination per policies and procedures.
  • Maintain accurate and complete documentation.
  • Collaborate with Medical Directors to determine medical necessity and appropriateness of care for benefits requested and/or rendered.
  • Work with clinical support staff to ensure service requests, authorizations and/or grievances are managed in accordance with state and federal guidelines.
  • Identify and refer potential quality of care issues for peer review.
  • Ensure that authorization decisions are based on organizational policy and state and federal coverage rules.
  • Gather and submit documents for third party case review; this includes all documentation and follow-up activities.
  • Issue denial notices based on established unit protocols and state and/or federal requirements.
  • Assist with periodic audits, general quality management and improvement activities, and other regulatory activities as needed.
  • Foster collaboration with teams across the Clinical Operations department to ensure work and goals are met.
  • Meet or exceed department production, timelines, and quality standards established for level I.
  • May participate in departmental workgroups or projects as assigned.
  • Support testing for system updates and implementations as assigned.
  • May help train new staff and teammates as assigned.
  • Cross train in additional functional focus areas as assigned.

Duties Specific to Functional Focus Area
  • Benefit Management
    • Review provider pre-service requests and determine benefit coverage according to Medicare, Medicaid and/or organizational guidelines.
  • Benefit Review
    • Determine appropriate level of care and length of stay for inpatient members to include hospitals, skilled nursing facilities, long term acute care hospitals, inpatient rehabilitation hospitals, and respite care programs.
    • Review inpatient admission for re-insurance clinical reporting.
  • Appeals and Grievance
    • Assemble evidence and build clinical cases for administrative hearings or Independent Review Entity (IRE) reviews.
    • Function as a CareOregon representative in administrative hearings.
    • Assist with the analysis and summary of data for written reports and public presentations as needed.
    • Communicate with members, providers, health plan administrators to manage grievances and appeals and provide case status updates as needed.
    • Investigate and use clinical judgement to identify quality of care or safety issues and present findings to an oversight committee.
  • Health Related Services
    • Review provider and member submitted HRSN and Flexible Services requests and determine benefit eligibility according to Medicaid and/or organizational guidelines.

Experience and/or Education
Required
  • Current unrestricted Oregon RN license
  • Minimum 2 years RN experience [OR 1 year RN experience AND 3 years' experience in healthcare setting role(s) such as billing, coding, medical assistant, etc.]

Preferred
  • More than 1 year RN experience
  • Healthcare utilization management experience in Prior Authorization UM
  • Experience with Medicaid and/or Medicare utilization management

Knowledge, Skills and Abilities Required
Knowledge
  • Knowledge of Medicaid health plan and Medicare benefits
  • Knowledge of applicable DMAP rules and regulations
  • Knowledge of ICD-10, CPT, and HCPCS codes
  • Familiarity with the principles of utilization management
  • Familiarity with healthcare documentation systems

Skills and Abilities
  • General computer skills including use of Microsoft Office applications and internet search functions
  • Ability to use review criteria in accordance with departmental policies
  • Ability to adhere to HIPAA regulations e.g., maintaining confidentiality of protected health information
  • Ability to interpret and apply complex policies and procedures
  • Ability to review work for accuracy
  • Ability to independently prioritize work
  • Ability to use critical thinking and problem-solving skills
  • Strong spoken and written communication skills
  • Strong interpersonal and customer service skills
  • Ability to work effectively with diverse individuals and groups
  • Ability to learn, focus, understand, and evaluate information and determine appropriate actions
  • Ability to accept direction and feedback, as well as tolerate and manage stress
  • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
  • Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

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