ZipRecruiter

Log In

2

Director Remote Utilization Review Jobs in Portland, OR

next page

Showing results 1-20

All JobsUtilization Review JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Portland, OR

Director Remote Utilization Review information

See Portland, OR salary details

$22

$44

$73

How much do director remote utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for director remote utilization review in Portland, OR is $44.84, according to ZipRecruiter salary data. Most workers in this role earn between $35.43 and $51.49 per hour, depending on experience, location, and employer.

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 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 are the most commonly searched types of Remote Utilization Review jobs in Portland, OR?

The most popular types of Remote Utilization Review jobs in Portland, OR are:

Director Remote Utilization Review jobs near you

RN Utilization Management Reviewer - Remote (OR, WA, AK)

PeaceHealth Career Site

Vancouver, WA • Remote

$48.52 - $72.78/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

PeaceHealth rating

7.7

Company rating: 7.7 out of 10

Based on 175 frontline employees who took The Breakroom Quiz

163rd of 898 rated healthcare providers

Job description

Description

Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are.

PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization Management (UM) Reviewer to join our dedicated team in a Full Time, Day Shift (1.0 FTE) role. If you enjoy analytical work and are energized by helping ensure patients receive the right care at the right time, this remote opportunity may be the perfect next step in your nursing career.

Why You'll Love This Role

As a Utilization Management Reviewer at PeaceHealth, you will play a key part in supporting safe, high-quality, and efficient patient care across our healthcare system. This position centers on concurrent and retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and technology tools to guide patient status determinations and promote appropriate utilization of hospital resources.

You'll work fully remote*, with PeaceHealth-provided computer equipment-empowered by a collaborative team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver well-being.

*Must reside in Washington, Oregon, or Alaska. PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access.

PeaceHealth's Total Rewards package supports your physical, emotional, financial, social, and spiritual wellbeing. Benefits include:

  • Pay Range: 48.52 - 72.78/hour
  • Full medical, dental, and vision coverage
  • 403(b) retirement plan with employer base and matching contributions
  • Paid time off and paid disability & life insurance (with buy-up options)
  • Tuition reimbursement and continuing education support
  • Robust wellness benefits, EAP, and expanded mental health programs
  • A culture grounded in Inclusivity, Respect for Diversity, and Cultural Humility

What You'll Do

  • Coordinate accurate patient status identification and documentation
  • Ensure correct admission status and reimbursement through certification and clinical review
  • Gather additional clinical documentation to validate treatment plans and level of care
  • Collaborate closely with physicians, clinicians, and multidisciplinary teams
  • Apply UM criteria using the Xsolis Dragonfly platform and PeaceHealth Care Level Score tools
  • Conduct pre-admission status reviews in the ED, patient access areas, and elective settings
  • Communicate with third-party payers regarding medical necessity and discharge progress
  • Support denial and appeal processes; refer cases for physician advisor review when appropriate
  • Participate in UM Committee work, quality initiatives, and performance improvement
  • Identify DRGs with complications/comorbidities and recommend documentation improvements
  • Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency
  • Perform other duties as needed to support UM and organizational goals

What You Bring

Education

  • Required: Bachelor of Science in Nursing (BSN)
  • Preferred: Master of Science in Nursing (MSN)

Experience

  • 3+ years of acute care hospital experience with strong clinical knowledge
  • In-depth understanding of Medicare/Medicaid UM regulations, RAC, QIO, MAC, and denial/appeals processes
  • Preferred: Prior experience in utilization management or case management

Credentials

  • Active RN license in your state of residence (WA, OR, or AK)

Ready to Make a Meaningful Impact?

Bring your clinical expertise, attention to detail, and passion for patient advocacy to a mission-driven healthcare system that believes in caring for caregivers as much as patients.

For full consideration, please attach a current resume with your application.

PeaceHealth is an EEO Affirmative Action Employer/Veterans/Disabled following all applicable state, local, and federal laws.

Employment Type:

What PeaceHealth employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

PeaceHealth logo

About PeaceHealth

Sourced by ZipRecruiter

PeaceHealth, based in Vancouver, WA, is a not-for-profit Catholic health system employing approximately 16,000 caregivers, a multi-specialty medical group practice with more than 1,200 providers and 10 medical centers serving both urban and rural communities in Washington, Oregon, Alaska. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, the legacy of its founding Sisters continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission. Get a feeling for the Spirit of PeaceHealth through this three-minute video, and visit us on Facebook or LinkedIn! We offer competitive compensation, a robust benefitspackage and a collaborative, Mission-driven work environment! To learn more please visit: jobs.peacehealth.org. Questions? Review our Employment FAQor email Recruitment@peacehealth.org. Please note this email does not accept resumes or applications.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Vancouver, WA, US

Year founded

1890

Social media

FacebookTwitter

View All PeaceHealth Jobs

Apply