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Remote Optum Utilization Review Jobs in Portland, OR

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Remote Optum Utilization Review information

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$22

$44

$73

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

As of Aug 22, 2026, the average hourly pay for remote optum 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 a Remote Optum Utilization Review?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review nurse?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

What are the most commonly searched types of Optum Utilization Review jobs in Portland, OR?

The most popular types of Optum Utilization Review jobs in Portland, OR are:

What are popular job titles related to Remote Optum Utilization Review jobs in Portland, OR?

For Remote Optum Utilization Review jobs in Portland, OR, the most frequently searched job titles are:

What job categories do people searching Remote Optum Utilization Review jobs in Portland, OR look for?

The top searched job categories for Remote Optum Utilization Review jobs in Portland, OR are:

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

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

Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Portland, OR as of August 2026, with employment types broken down into 100% Full Time. Highlights an 10% Hybrid, and 90% Remote job distribution, with an average salary of $93,268 per year, or $44.8 per hour.

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 3 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.

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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

Social media

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