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Part Time Utilization Review Jobs in Oregon (NOW HIRING)

Asante

Case Management Specialist

Medford, OR · On-site

$23.28 - $32.02/hr

... utilization review, and denials management activities as defined by the RN Discharge Coordinator ... Medical, dental, and vision coverage for part-time and above employees and their eligible ...

Personify Health

This is a part-time position. What You'll Actually Do Essential Functions/Responsibilities/Duties ... Perform Utilization Review for assigned members. * Serve as mentors to LVNs and provide guidance on ...

Personify Health

This is a part-time position. What You'll Actually Do Essential Functions/Responsibilities/Duties ... Perform Utilization Review for assigned members. * Serve as mentors to LVNs and provide guidance on ...

Personify Health

This is a part-time position. What You'll Actually Do Essential Functions/Responsibilities/Duties ... Perform Utilization Review for assigned members. * Serve as mentors to LVNs and provide guidance on ...

Personify Health

This is a part-time position. What You'll Actually Do Essential Functions/Responsibilities/Duties ... Perform Utilization Review for assigned members. * Serve as mentors to LVNs and provide guidance on ...

Pacs

Occupational Therapist (Part Time)

Creswell, OR · On-site

$37.75 - $49.75/hr

Participates in Resident Care conferences, Utilization Review meetings, and Rehabilitation meetings as needed. * Provides in-services on training programs for other staff in the facility as needed.

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Part Time Utilization Review information

How to make an extra 2000 a month as a nurse?

A part time utilization review nurse can increase income by taking on additional shifts, working overtime, or handling cases outside regular hours. Developing specialized skills or certifications, such as in case management or insurance review, can also qualify for higher-paying opportunities or freelance work, helping to reach the extra income goal.

How to get a utilization review job?

To obtain a utilization review position, candidates typically need a background in healthcare, such as nursing, health administration, or related fields, along with knowledge of insurance and medical billing. Relevant certifications like the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can improve job prospects, and strong analytical and communication skills are essential. Experience with medical records and utilization review software is also beneficial.

What is a Part Time Utilization Review job?

A Part Time Utilization Review job involves evaluating healthcare services provided to patients in order to ensure they are medically necessary and cost-effective. Professionals in this role review patient records, treatment plans, and insurance information to make recommendations about the appropriateness of care. Working part-time, they may collaborate with healthcare providers, insurance companies, and patients to optimize healthcare outcomes while managing costs. This position is often found in hospitals, insurance companies, or healthcare management organizations, and typically requires a background in nursing or healthcare administration.

What are some common challenges faced in a part-time utilization review role and how can I effectively manage them?

Part-time utilization review professionals often face challenges such as managing fluctuating caseloads within limited hours and staying up-to-date with rapidly changing healthcare regulations. Balancing efficiency and thoroughness is crucial, especially when reviewing complex cases or communicating with providers on tight timelines. Effective time management, strong organizational skills, and clear communication with your team are key to overcoming these challenges. Many employers provide flexible schedules and supportive technology platforms, which can help streamline your workflow and maintain high-quality reviews.

Is utilization review a stressful job?

Utilization review is a role that involves evaluating healthcare services for appropriateness and coverage, which can be stressful due to strict deadlines, high accuracy requirements, and the need to handle complex cases. The level of stress varies depending on the work environment, workload, and individual coping skills, but it generally requires attention to detail and strong communication skills. Some professionals find the job manageable with proper time management and support systems in place.

What is the difference between Part Time Utilization Review vs Part Time Case Management?

AspectPart Time Utilization ReviewPart Time Case Management
CredentialsTypically requires healthcare-related certifications (e.g., RN, LPN, or medical reviewer credentials)Often requires social work, nursing, or healthcare certifications, with some overlap
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsHospitals, insurance companies, or community health agencies
Employer & Industry UsageUsed mainly in insurance and healthcare to evaluate medical necessityUsed in healthcare to coordinate patient care and services

Part Time Utilization Review focuses on assessing the medical necessity of services, while Part Time Case Management involves coordinating patient care and services. Both roles require healthcare credentials and are common in insurance and healthcare settings, but they serve different functions within patient care and resource management.

What are the key skills and qualifications needed to thrive as a Part Time Utilization Review Nurse, and why are they important?

To thrive as a Part Time Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and experience in case management or utilization review. Familiarity with healthcare management systems, InterQual or MCG guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, attention to detail, and effective communication help in collaborating with healthcare providers and payers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes in a part-time capacity.

What jobs pay 4000 a week without a degree?

Part Time Utilization Review roles typically do not pay $4,000 a week; such high earnings usually require full-time positions or specialized skills. Jobs that can reach this level without a degree often include sales, real estate, or certain freelance consulting roles, but they generally demand experience, certifications, or a strong network. Most high-paying roles without a degree involve sales, entrepreneurship, or skilled trades with commission or performance-based pay structures.
What are the most commonly searched types of Utilization Review jobs in Oregon? The most popular types of Utilization Review jobs in Oregon are:
What are popular job titles related to Part Time Utilization Review jobs in Oregon? For Part Time Utilization Review jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Part Time Utilization Review jobs in Oregon look for? The top searched job categories for Part Time Utilization Review jobs in Oregon are:
What cities in Oregon are hiring for Part Time Utilization Review jobs? Cities in Oregon with the most Part Time Utilization Review job openings:
Part Time Utilization Review jobs near you
Clinical Resource Manager Part-Time Days

Clinical Resource Manager Part-Time Days

Trinity Health

Baker City, OR • On-site

Part-time

Life, Retirement, PTO

Posted 2 days ago

Trinity Health rating

6.5

Company rating: 6.5 out of 10

Based on 351 frontline employees who took The Breakroom Quiz

595th of 877 rated healthcare providers

Job description

Employment Type:
Part timeShift:
Day Shift
Description:
At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.
CLINICAL RESOURCE MANAGER
BAKER CITY, Part-time
GENERAL SUMMARY AND PURPOSE:
Provides hospital case management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care, providing decision support to patients/families and physicians, managing patient and family expectations, and ensuring a smooth transition to the next level of care and services. Coordinates the integration of social services into patient care as appropriate. Coordinates the hospital activities concerned with case management/utilization review and discharge planning. Adheres to departmental goals, objectives, standards of practice, and policies and procedures. Ensures quality patient care and adheres to regulatory compliance. Provides concurrent assistance and support to physicians and other clinical members of the health care team in coordinating the delivery of services for a select group of patients. To help achieve quality clinical and cost outcomes, incorporates real-time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and to facilitate transition planning.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
  • Colleague must have an RN license in Oregon.
  • IDAHO ONLY: Multistate licenses must establish residency with the Idaho Board of Nursing within 60 days from hire.
  • All colleagues must provide licensure or proof of application in process for an Oregon RN license within 90 days of the hire date.
  • BSN required. A master's degree is preferred.
  • A minimum of 2 years of varied hospital clinical experience is required.
  • Experience in case management, home health, and/or the insurance industry preferred.

HOURS AND ENVIRONMENT: You will have outstanding work-life balance as this position requires two days a week, with Wednesdays required. The hours will be 7am-3pm. No weekends. No evenings. No holidays. The position is in small, close-knit, supportive, critical access hospital.
ESSENTIAL FUNCTIONS:
  • Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.
  • Demonstrates knowledge and skills to competently care for all assigned age groups.
  • Ensures the accuracy of documenting services and supplies provided to the patients.
  • Coordinates the integration of social services/case management functions into patient care, discharge, and home planning process with other hospital departments, external service organizations, agencies and healthcare facilities. Completes a screening/assessment of physician assigned cases to determine medical necessity/status determinations and transition needs.
  • Reassesses, monitors, and modifies transition needs as appropriate.
  • Conducts concurrent medical record review using established medical necessity criteria to determine correct level of care for acute patients.
  • Assists physicians with completing transfer and discharge orders.
  • Maintains knowledge of federal, state, and private agency review requirements and regulations.
  • Provides education to all health care team members including physicians regarding requirements to meet regulatory standards.
  • Promotes effective and efficient utilization of clinical resources from admission to discharge.
  • Initiates and presents "denial letters" as appropriate.
  • Completes PASRRs for admission to skilled nursing facilities.
  • Delivers Condition Code 44 letters to patients and educates them on Medicare benefits.
  • Researches and locates resources for patients for example: assistance in competing medication applications for financial assistance through pharmaceutical companies, works closely with our Patient Financial Advocates in the Medicaid pending process, and works closely with outside facilities to obtain equipment in situations when patients have limited funding available to them. Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship.
  • Assists physicians to maintain appropriate cost, cases, and desired patient outcomes.
  • Introduces self to patient and family and explains clinical resource manager role and the process for patient and family to contact clinical resource manager. Serves as a patient advocate.
  • Enhances a cllaborative relationship to maximize the patient's and family's ability to make informed decisions.
  • Participates in multidisciplinary patient care rounds and/or conferences as appropriate to review treatment goals, optimize resource utilization, provides family education and identification of post-hospital needs.
  • Utilizes physician advisor referral as appropriate.
  • Adheres to department established process in reviewing 30 day re-admissions. Follows established patient choice policy.
  • Documents assessment of primary and back up plans along with communications to patient, family and care team.
  • Documents interventions taken to meet the needs of their individual patients in Power Chart.
  • Actively participates in department staff meetings and department sub teams.
  • Ensures discharge planning compliance with Medicare Conditions of Participation/regulations and Joint Commission standards,

Highlights and Benefits:
When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.
  • We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.
  • Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.
  • We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.

Ministry/Facility Information:
Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 90 ambulatory locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.
  • Top 15 Health Systems in the country by IBM Watson Health;
  • The region's most advanced Trauma Center (Level II);
  • Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life

Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

What Trinity Health employees say

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Hours and flexibility

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About Trinity Health

Sourced by ZipRecruiter

Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Livonia, MI, US

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