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Manager Utilization Management Jobs in Portland, OR

Adventist Health

Chart Auditor (Portland)

Portland, OR · On-site

$52.55 - $78.77/hr

Collaborates with Case Management, Utilization Management, Coding, Medical Officer, and Physician Advisors to reduce clinical denials, improve documentation quality, and ensure compliance with ...

Legacy Health

Mgr, Care Management Social

Portland, OR · On-site

We are seeking an experienced and compassionate Manager of Care Management to lead the daily operations of our Social Work, Utilization Management, and Access Intake & Referral teams. In this dynamic ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Portland, OR

Manager Utilization Management information

See Portland, OR salary details

$41.4K

$96.5K

$177.6K

How much do manager utilization management jobs pay per year?

As of Aug 9, 2026, the average yearly pay for manager utilization management in Portland, OR is $96,518.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,100.00 and $116,100.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Portland, OR? The most popular types of Utilization Management jobs in Portland, OR are:
What are popular job titles related to Manager Utilization Management jobs in Portland, OR? For Manager Utilization Management jobs in Portland, OR, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Portland, OR look for? The top searched job categories for Manager Utilization Management jobs in Portland, OR are:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Portland, OR as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $96,518 per year, or $46.4 per hour.

RN, Health Plan Care Manager

Adventist Health

Portland, OR

Full-time

Re-posted 29 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 243 frontline employees who took The Breakroom Quiz

159th of 887 rated healthcare providers

Job description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Manages the development, implementation and evaluation of the cavitation care management service lines. Enhances the quality of member management by promoting continuity of care and cost effectiveness through whole person in-patient and out-patient management, care integration, case management, utilization review and care planning.

Job Requirements:

Education and Work Experience:

  • Bachelor's Degree in Nursing (BSN): Preferred
  • Nursing experience: Preferred

Licenses/Certifications:

  • Certified Case Manager (CCM): Preferred
  • Registered Nurse (RN) licensure in the state of practice: Required

Essential Functions:

  • Partners with internal and external physician advisors, as well as claims department and data management and analytics department to provide safeguards, processes and expected outcomes for the Health Plan's member population. Perform and/or coordinate preventative care, wellness, and nutritional counseling to Members. Develops and maintains positive relationships with customers internal and external.
  • Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives.
  • Performs ongoing collaboration with staff to ensure a member's medical condition meets medical necessity criteria. Communicates changes that could affect the discharge plan of care.
  • Manages communication related to discharge planning and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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