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Insurance Utilization Review Jobs in Portland, OR

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Insurance Utilization Review information

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$22

$44

$73

How much do insurance utilization review jobs pay per hour?

As of Sep 6, 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 is an insurance utilization review?

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 the key skills and qualifications needed to thrive in insurance utilization review?

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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

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 August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 22% Part Time, and 5% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $93,268 per year, or $44.8 per hour.

Travel Nurse RN - Case Management at LanceSoft Portland, OR

Shell Lubricants Hub Hamburg

Portland, OR • On-site

$70 - $90/hr

Other

Medical

Posted 18 days ago

Job description

Travel Nurse RN - Case Management

Position: Travel Nurse RN – Case Management in Portland, OR.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 01/05/2026
  • Duration: 24 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Position Requirements / Experience & Ratios
  • Expected ratios: 1:20
  • Required, Epic experience.
Certifications
  • Required: BLS
  • Preferred: Case Management Certification
Skills (Preferred Skills Marked *) Case Management / Utilization Review
  • Admission Criteria*
  • Benefits Eligibility*
  • Care Coordination
  • Continued Stay Reviews*
  • Discharge Planning
  • Needs Assessment / DME Orders
  • Plan of Care
  • Prior Authorizations
Regulatory Knowledge
  • CMS
  • DRG
  • HEDIS Measures
  • HIPAA Guidelines
  • NCQA
  • OSHA
  • The Joint Commission / Core Measures / National Safety Goals
Work Settings
  • Acute Hospital
  • Behavioral Health*
  • Home Health*
  • Hospice*
  • Insurance Company*
  • LTAC / Rehab / Skilled Nursing*
Schedule & Logistics
  • Weekends: Yes, every other weekend
  • On-call: No
  • Block Scheduling: Unknown
  • Holiday Requests: Traveler may request standard and/or holiday time off (only one of the three major holidays); approvals at client discretion
  • 48s: Not approved
Floating Requirements
  • Floating required per unit needs
  • Travelers may float to multiple facilities based on skill set
  • Facilities:
    • Milwaukie
    • Newberg
    • Portland
    • Hood River
    • Willamette Falls
    • Seaside
    • Saint Vincent
Seaside Floating Incentives
  • +$5/hr incentive for hours worked at Seaside
  • IRS mileage reimbursement
  • Hotel offered for consecutive shifts
  • Facility will give as much notice as possible
Additional Requirements
  • Must have a vehicle for this assignment
  • Must be able to float to other units and facilities as required
Benefits
  • Weekly pay
  • Medical benefits
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