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Insurance Utilization Review Jobs in Portland, OR

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$22

$44

$73

How much do insurance utilization review jobs pay per hour?

As of Jun 25, 2026, the average hourly pay for insurance 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 are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Portland, OR? For Insurance Utilization Review jobs in Portland, OR, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Portland, OR look for? The top searched job categories for Insurance Utilization Review jobs in Portland, OR are:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Portland, OR as of June 2026, with employment types broken down into 13% Full Time, 83% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $93,268 per year, or $44.8 per hour.
Radiation Oncology Utilization Splst

Radiation Oncology Utilization Splst

Legacy Health

Portland, OR • On-site

$29.89 - $42.74/hr

Full-time

Posted 12 days ago

Job description

The Utilization Review/Utilization Management (UR/UM) Specialist is responsible for reviewing medical services for appropriateness, medical necessity, and efficiency. This role ensures that patient care aligns with established guidelines and payer policies while optimizing resource utilization. The specialist collaborates with healthcare providers, insurance companies, and case management teams to facilitate timely authorizations and appeals when necessary.


Education:

  • Associate's or Bachelor's degree in Radiation Therapy, Health Administration, or a related field preferred; 2-5 years oncology experience; utilization review or prior authorization experience required.

Experience:

  • 2-5 years in utilization review, case management, or prior authorization, preferably in a hospital or managed care setting.
  • Strong understanding of medical necessity criteria, insurance policies, and reimbursement guidelines.
  • Proficiency in electronic medical records (EMR), payer portals, and utilization management software.
  • Excellent communication and problem-solving skills.
  • Ability to work independently and manage multiple cases simultaneously.
  • Knowledge of regulatory requirements (e.g., Medicare, Medicaid, commercial insurance).

USD $29.89 - USD $42.74 /Hr.

Our Legacy is good for health for Our People, Our Patients, Our Communities, Our World. Above all, we will do the right thing.


If you are passionate about our mission and believe you can contribute to our team, we encourage you to apply—even if you don't meet every qualification listed. We are committed to fostering an inclusive environment where everyone can grow and succeed.


Legacy Health is an equal opportunity employer and prohibits unlawful discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion or creed, citizenship status, sex, sexual orientation, gender identity, pregnancy, age, national origin, disability status, genetic information, veteran status, or any other characteristic protected by law.

To learn more about our employee benefits click here: www.legacyhealth.org/For-Health-Professionals/careers/benefiting-you

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