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Remote Utilization Management Jobs in Portland, OR

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Remote Utilization Management information

See Portland, OR salary details

$22

$44

$73

How much do remote utilization management jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for remote utilization management 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 remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

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 Remote Utilization Management jobs in Portland, OR?

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

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

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

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

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

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Portland, OR as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% 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)

Vancouver, WA • On-site, Remote

PeaceHealth
Health Care and Social Assistance • 10K+ employees

7.7

Company rating: 7.7 out of 10

Based on 175 frontline employees who took The Breakroom Quiz

160th of 893 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about PeaceHealthexternal

$48.52 - $72.78/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

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.
PeaceHealth logo

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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