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Director Remote Utilization Review Jobs in Oregon

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Escalate complex cases to Medical Directors and request additional documentation as needed

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site +1

$80K - $94K/yr

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Director review. * Request and evaluate additional clinical information from providers and members ...

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

Five9

Mid-Market Sales Director (Remote)

OR · On-site +1

The Sales Director's primary responsibility is to acquire new customers and drive revenue. A ... Develop business plan and present the business plan during quarterly review sessions * Maintain ...

Embark Behavioral Health

Director of Payer Compliance

OR · On-site +1

$120K - $130K/yr

Remote Reporting to: Chief Financial Officer The Director of Payer Compliance is a senior ... Conduct targeted audits of clinical documentation, utilization review practices, and workflows to ...

Embark Behavioral Health

Director of Payer Compliance

OR · On-site +1

$120K - $130K/yr

Remote Reporting to: Chief Financial Officer The Director of Payer Compliance is a senior ... Conduct targeted audits of clinical documentation, utilization review practices, and workflows to ...

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

New

CCS Fundraising

Director, Staffing

Remote; however, this role requires working Eastern Time business hours. REPORTS TO: SVP, Head of ... Partner with Business Systems to align staffing data with project tracking, utilization metrics ...

Bcbsa

Director, Trade Client Relations

OR · On-site +1

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Centene

Psychologist Reviewer

OR · On-site +1

$87K - $157K/yr

... utilization management processes * Interact with the Medical Director, or designee, to discuss ... review by a PhD/PsyD * Facilitate outpatient rounds offering clinical input and oversight related ...

Mineralys Therapeutics

National Sales Director

OR · On-site +1

$260K - $285K/yr

... remote company. National Sales Director The National Sales Director (NSD) will serve as a senior ... Conduct regular field coaching, business reviews, and talent assessments * Build leadership bench ...

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All JobsUtilization Review JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Oregon

Director Remote Utilization Review information

What is the difference between Director Remote Utilization Review vs Utilization Review Nurse?

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What is a director of remote utilization review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

How does a director of remote utilization review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What are the key skills and qualifications needed to thrive as a director of remote utilization review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.

What are the most commonly searched types of Remote Utilization Review jobs in Oregon?

The most popular types of Remote Utilization Review jobs in Oregon are:

What cities in Oregon are hiring for Director Remote Utilization Review jobs?

Cities in Oregon with the most Director Remote Utilization Review job openings:

Director Remote Utilization Review jobs near you
Infographic showing various Director Remote Utilization Review job openings in Oregon as of July 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, 1% Temporary, and 1% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 days ago

Job description

UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations.
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
  • Perform clinical assessments and prior authorizations to determine medical necessity
  • Escalate complex cases to Medical Directors and request additional documentation as needed
  • Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
  • Liaise with internal departments to resolve eligibility, benefits, or service issues
  • Participate in discharge planning for members transitioning from acute, long-term, or residential care
  • Conduct audits and support quality improvement initiatives
  • Provide training and mentorship on UM protocols and workflows
  • Maintain relationships with community providers and service organizations
  • Ensure compliance with organizational policies, clinical standards, and federal/state regulations
  • Perform other nursing-related duties as assigned

CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS
  • Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state
  • Graduation from an accredited nursing program
  • Minimum 5 years of direct patient care experience
  • Proficiency with Microsoft Office, EHR systems, and UM software
  • Strong clinical knowledge, communication, and organizational skills
  • No suspension, exclusion, or debarment from federal healthcare programs

PREFERRED QUALIFICATIONS
  • 2+ years of utilization review or case management experience in managed care
  • Oregon residency and license
  • Bilingual or translation skills a plus
  • Experience with quality improvement audits and diverse team collaboration
  • Ability to work independently in fast-paced environments
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
BENEFITS
  • Salary is dependent on skills, experience, and education
  • Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
  • Medical, dental, and vision insurance
  • 401(k) with company match (fully vested immediately)
  • Company-sponsored life insurance and additional benefits
  • Fitness reimbursement program
  • Tuition reimbursement and more

Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

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