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Insurance Reviewer Jobs in Remote, OR (NOW HIRING)

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 ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

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All JobsInsurance Reviewer JobsInsurance Reviewer Jobs in Remote, OR

Insurance Reviewer information

See Remote, OR salary details

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$29

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How much do insurance reviewer jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for insurance reviewer in Remote, OR is $29.85, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.49 per hour, depending on experience, location, and employer.

What are some common challenges faced by Insurance Reviewers and how can they be addressed?

Insurance Reviewers often encounter challenges such as interpreting complex policy language, managing high volumes of documentation, and staying updated with frequently changing regulations. To address these, many reviewers develop strong organizational skills, utilize specialized software to streamline document management, and participate in ongoing training or professional development. Collaborating closely with underwriters, claims adjusters, and legal teams also helps ensure accurate and timely policy assessments, reducing the risk of errors.

What does an Insurance Reviewer do?

An Insurance Reviewer is responsible for evaluating insurance claims, policies, and related documents to ensure compliance with company and regulatory guidelines. They review submitted claims to determine their validity, check for completeness and accuracy, and may communicate with policyholders or healthcare providers for additional information. Insurance Reviewers help prevent fraud, reduce errors, and ensure that claims are processed fairly and efficiently. Their work is crucial in maintaining the integrity and cost-effectiveness of an insurance company's operations.

What are the key skills and qualifications needed to thrive as an Insurance Reviewer, and why are they important?

To thrive as an Insurance Reviewer, you need strong analytical skills, attention to detail, and a solid understanding of insurance policies and regulations, often supported by relevant experience or a degree in business or finance. Familiarity with claims management systems, insurance software, and sometimes certifications like AINS (Associate in General Insurance) are typically required. Excellent communication, problem-solving abilities, and organizational skills help you manage cases efficiently and interact with clients or colleagues. These competencies ensure accurate claim assessments, compliance with industry standards, and high-quality customer service.
What are popular job titles related to Insurance Reviewer jobs in Remote, OR? For Insurance Reviewer jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Insurance Reviewer jobs in Remote, OR look for? The top searched job categories for Insurance Reviewer jobs in Remote, OR are:
Insurance Reviewer jobs near you
Infographic showing various Insurance Reviewer job openings in Remote, OR as of June 2026, with employment types broken down into 98% Full Time, and 2% Part Time. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $62,098 per year, or $29.9 per hour.
Utilization Review Nurse

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, 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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