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Manager Optum Utilization Review Jobs in Oregon (NOW HIRING)

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR ... Manage intake, tracking, and routing of prior authorization requests and supporting documentation.

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...

Providence Service

Utilization Review RN

Portland, OR · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Description Utilization Review RN at Providence Health Plaza ... Utilization Management covers 7 days/week, including holidays. This posting is not for a specific ...

St. Charles Health System

RN Utilization Review

Bend, OR · On-site

$48.30 - $72.45/hr

Manager- Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: November 2024 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love ...

Stcharles

RN Utilization Review

Bend, OR · On-site

$48.30 - $72.45/hr

Manager- Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: November 2024 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love ...

St. Charles Health System

RN Utilization Review

Bend, OR · On-site

$48.30 - $72.45/hr

Manager- Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: November 2024 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site +1

$80K - $94K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

ESSENTIAL JOB RESPONSIBILITIES Behavioral Health Utilization Management * Evaluate behavioral ... Review behavioral health, Health-Related Social Needs (HRSN), and Flexible Services requests for ...

P3 Health Partners

Concurrent Review RN

Salem, OR · On-site

$90K - $100K/yr

  • Medical

  • Vision

What You'll Do As a Concurrent Review RN, you'll leverage your clinical expertise and utilization management knowledge to evaluate medical necessity, coordinate care transitions, and collaborate with ...

P3 Health Partners

Concurrent Review RN

Salem, OR · On-site

$90K - $100K/yr

  • Medical

  • Vision

What You'll Do As a Concurrent Review RN, you'll leverage your clinical expertise and utilization management knowledge to evaluate medical necessity, coordinate care transitions, and collaborate with ...

P3 Health Partners

Concurrent Review RN

Salem, OR · On-site

$90K - $100K/yr

  • Medical

  • Vision

What You'll Do As a Concurrent Review RN, you'll leverage your clinical expertise and utilization management knowledge to evaluate medical necessity, coordinate care transitions, and collaborate with ...

PacificSource

Utilization Management Clinician

Bend, OR · On-site

  • Medical

Perform concurrent review of members admitted to inpatient facilities, residential treatment ... Case Manager Certification as accredited by CCMC preferred. Knowledge: Thorough knowledge and ...

PacificSource

Utilization Management Clinician

Bend, OR · On-site

  • Medical

Perform concurrent review of members admitted to inpatient facilities, residential treatment ... Case Manager Certification as accredited by CCMC preferred. Knowledge: Thorough knowledge and ...

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Manager Optum Utilization Review information

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

What are the key skills and qualifications needed to thrive as a manager Optum Utilization Review, and why are they important?

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

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

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

What are popular job titles related to Manager Optum Utilization Review jobs in Oregon?

For Manager Optum Utilization Review jobs in Oregon, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Oregon look for?

The top searched job categories for Manager Optum Utilization Review jobs in Oregon are:

What cities in Oregon are hiring for Manager Optum Utilization Review jobs?

Cities in Oregon with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Oregon as of June 2026, with employment types broken down into 77% Full Time, 11% Part Time, 11% Contract, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution.

Utilization Review Specialist

Umpqua Health

Winston, OR • On-site

$41K - $47K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 28 days ago

Job description

Utilization Review Specialist
HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470
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 Review Specialist supports Umpqua Health Alliance by coordinating the intake, review, processing, and completion of prior authorization requests within Medical Management. This role is responsible for ensuring accurate and timely handling of authorizations, maintaining compliance with regulatory and organizational requirements, supporting communication with providers and members, and assisting with workflow coordination to promote efficient utilization management operations.
ESSENTIAL JOB RESPONSIBILITIES
  • Support Utilization Review activities related to the prior authorization process.
  • Manage intake, tracking, and routing of prior authorization requests and supporting documentation.
  • Review requests for completeness and ensure appropriate routing for processing.
  • Communicate with healthcare providers to obtain additional information and resolve documentation issues.
  • Track prior authorization requests using established systems to ensure timely processing.
  • Support timely notification of prior authorization determinations.
  • Coordinate daily workflow and telephone coverage with team members.
  • Respond to internal and external inquiries regarding prior authorizations and route as appropriate.
  • Monitor and report on turnaround times to ensure compliance with requirements.
  • Maintain knowledge of applicable regulations, policies, and procedures.
  • Comply with organizational policies and applicable to federal, state, and local regulations.
CHALLENGES
  • Strong organizational skills with the ability to stay organized and productive in a remote, independent work environment
  • Proactive communication with internal and external stakeholders
  • Consistent ability to meet Oregon Health Plan (OHA) timeline and turnaround requirements
  • Ability to manage shifting priorities in a fast-paced environment
  • Ability to coordinate tasks and resources to meet operational goals and objectives
MINIMUM QUALIFICATIONS
  • High school diploma or equivalent.
  • Proficient computer skills, including Microsoft Office Suite (Word, Excel, Outlook, Teams), data entry, and internet research.
  • Experience using standard office equipment and systems, including keyboarding, web-based phone systems, and cloud-based document storage.
  • Ability to type a minimum of 45 words per minute with a high degree of accuracy.
  • Strong attention to detail.
  • No suspension, exclusion, or debarment from participation in federal healthcare programs (e.g., Medicare/Medicaid)
PREFERRED QUALIFICATIONS
  • 1+ years of experience in healthcare, managed care, medical coding, claims processing, or a related field
  • Knowledge of medical terminology, procedure codes, and diagnosis codes
  • Familiarity with Oregon Health Plan (OHP) and Coordinated Care Organizations (CCO), including applicable regulations (OAR, ORS, CFR, CMS, DMAP)
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
  • Ability to meet deadlines while maintaining accuracy and attention to detail
  • Strong communication and customer service skills (written, verbal, and interpersonal)
  • Ability to work independently and collaboratively with sound judgment and confidentiality
  • Strong critical thinking and time management skills
  • Self-motivated with ability to follow policies, procedures, and workflows in a remote environment
  • Flexible and adaptable in a changing work environment
  • Willingness to learn and take on additional responsibilities as needed
  • Ability to work a standard schedule: Monday-Friday, 8:00 AM-5:00 PM PST
  • Experience working in diverse teams and with varied communication styles
  • Experience considering the impact of work on diverse communities, including communities of color
  • Bilingual or translation skills preferred

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band : $41,600- $47,000
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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