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Remote Optum Health Utilization Review Jobs in Portland, OR

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Remote Optum Health Utilization Review information

See Portland, OR salary details

$22

$44

$73

How much do remote optum health utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote optum health 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 the difference between Remote Optum Health Utilization Review vs Remote UnitedHealth Group Utilization Review?

AspectRemote Optum Health Utilization ReviewRemote UnitedHealth Group Utilization Review
CertificationsTypically requires RN, LPN, or medical reviewer credentialsSimilar certifications, often RN or licensed healthcare professionals
Work EnvironmentRemote, healthcare insurance settingRemote, healthcare insurance setting
Employer & IndustryOptum, part of UnitedHealth Group, healthcare and insuranceUnitedHealth Group, healthcare and insurance
Job ResponsibilitiesReview medical necessity, authorizations, and claimsReview medical necessity, authorizations, and claims

Both roles involve remote medical review within the healthcare insurance industry, focusing on medical necessity and claims. The main difference lies in the specific employer, with Optum being a subsidiary of UnitedHealth Group. The certifications, work environment, and job responsibilities are very similar, making them comparable roles for healthcare professionals seeking remote utilization review positions.

What cities near Portland, OR are hiring for Remote Optum Health Utilization Review jobs?

Cities near Portland, OR with the most Remote Optum Health Utilization Review job openings:

Remote Optum Health Utilization Review jobs near you

RN Utilization Management Reviewer - Remote (OR, WA, AK)

PeaceHealth

Vancouver, WA • On-site, Remote

$48.52 - $72.78/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

PeaceHealth rating

7.7

Company rating: 7.7 out of 10

Based on 175 frontline employees who took The Breakroom Quiz

160th of 891 rated healthcare providers

Job description

Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are.
PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization Management (UM) Reviewer to join our dedicated team in a Full Time, Day Shift (1.0 FTE) role. If you enjoy analytical work and are energized by helping ensure patients receive the right care at the right time, this remote opportunity may be the perfect next step in your nursing career.
Why You'll Love This Role
As a Utilization Management Reviewer at PeaceHealth, you will play a key part in supporting safe, high-quality, and efficient patient care across our healthcare system. This position centers on concurrent and retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and technology tools to guide patient status determinations and promote appropriate utilization of hospital resources.
You'll work fully remote*, with PeaceHealth-provided computer equipment-empowered by a collaborative team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver well-being.
*Must reside in Washington, Oregon, or Alaska. PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access.
PeaceHealth's Total Rewards package supports your physical, emotional, financial, social, and spiritual wellbeing. Benefits include:
  • Pay Range: $48.52 - $72.78/hour
  • Full medical, dental, and vision coverage
  • 403(b) retirement plan with employer base and matching contributions
  • Paid time off and paid disability & life insurance (with buy-up options)
  • Tuition reimbursement and continuing education support
  • Robust wellness benefits, EAP, and expanded mental health programs
  • A culture grounded in Inclusivity, Respect for Diversity, and Cultural Humility

What You'll Do
  • Coordinate accurate patient status identification and documentation
  • Ensure correct admission status and reimbursement through certification and clinical review
  • Gather additional clinical documentation to validate treatment plans and level of care
  • Collaborate closely with physicians, clinicians, and multidisciplinary teams
  • Apply UM criteria using the Xsolis Dragonfly™ platform and PeaceHealth Care Level Score tools
  • Conduct pre-admission status reviews in the ED, patient access areas, and elective settings
  • Communicate with third-party payers regarding medical necessity and discharge progress
  • Support denial and appeal processes; refer cases for physician advisor review when appropriate
  • Participate in UM Committee work, quality initiatives, and performance improvement
  • Identify DRGs with complications/comorbidities and recommend documentation improvements
  • Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency
  • Perform other duties as needed to support UM and organizational goals

What You Bring
Education
  • Required: Bachelor of Science in Nursing (BSN)
  • Preferred: Master of Science in Nursing (MSN)

Experience
  • 3+ years of acute care hospital experience with strong clinical knowledge
  • In-depth understanding of Medicare/Medicaid UM regulations, RAC, QIO, MAC, and denial/appeals processes
  • Preferred: Prior experience in utilization management or case management

Credentials
  • Active RN license in your state of residence (WA, OR, or AK)

Ready to Make a Meaningful Impact?
Bring your clinical expertise, attention to detail, and passion for patient advocacy to a mission-driven healthcare system that believes in caring for caregivers as much as patients.
For full consideration, please attach a current resume with your application.
PeaceHealth is an EEO Affirmative Action Employer/Veterans/Disabled following all applicable state, local, and federal laws.

What PeaceHealth employees say

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About PeaceHealth

Sourced by ZipRecruiter

PeaceHealth, based in Vancouver, WA, is a not-for-profit Catholic health system employing approximately 16,000 caregivers, a multi-specialty medical group practice with more than 1,200 providers and 10 medical centers serving both urban and rural communities in Washington, Oregon, Alaska. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, the legacy of its founding Sisters continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission. Get a feeling for the Spirit of PeaceHealth through this three-minute video, and visit us on Facebook or LinkedIn! We offer competitive compensation, a robust benefitspackage and a collaborative, Mission-driven work environment! To learn more please visit: jobs.peacehealth.org. Questions? Review our Employment FAQor email Recruitment@peacehealth.org. Please note this email does not accept resumes or applications.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Vancouver, WA, US

Year founded

1890

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