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Remote Weekend Utilization Review Jobs in Oregon

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua ...

Personify Health

Lead Utilization Review-RN

Remote leadership effectiveness: dependable attendance, organization, and ability to troubleshoot ... Prior supervisory experience in utilization review, case management, or an equivalent combination ...

Personify Health

Lead Utilization Review-RN

Remote leadership effectiveness: dependable attendance, organization, and ability to troubleshoot ... Prior supervisory experience in utilization review, case management, or an equivalent combination ...

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All JobsUtilization Review JobsRemote Weekend Utilization Review JobsRemote Weekend Utilization Review Jobs in Oregon

Remote Weekend Utilization Review information

What is the difference between Remote Weekend Utilization Review vs Remote Weekday Utilization Review?

AspectRemote Weekend Utilization ReviewRemote Weekday Utilization Review
CredentialsTypically requires a healthcare professional license and utilization review certificationSame as weekend role, healthcare license and utilization review certification
Work EnvironmentRemote, weekend hours, often part-time or flexibleRemote, weekday hours, standard business hours
Employer & IndustryHealth insurance companies, third-party administratorsSame as weekend role, health insurance industry
Work SchedulePrimarily weekends, possibly eveningsWeekdays, regular business hours

Remote Weekend Utilization Review and Remote Weekday Utilization Review roles are similar in credentials and industry but differ mainly in work schedule. Weekend roles focus on reviewing cases during weekends, offering flexibility, while weekday roles follow standard business hours. Both positions require healthcare licensing and utilization review certification, serving health insurance companies and third-party administrators.

What are the most commonly searched types of Weekend Utilization Review jobs in Oregon? The most popular types of Weekend Utilization Review jobs in Oregon are:
What are popular job titles related to Remote Weekend Utilization Review jobs in Oregon? For Remote Weekend Utilization Review jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Remote Weekend Utilization Review jobs in Oregon look for? The top searched job categories for Remote Weekend Utilization Review jobs in Oregon are:
What cities in Oregon are hiring for Remote Weekend Utilization Review jobs? Cities in Oregon with the most Remote Weekend Utilization Review job openings:
Remote Weekend Utilization Review jobs near you
Utilization Review Nurse

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

UTILIZATION REVIEW NURSE
REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations.
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
  • Perform clinical assessments and prior authorizations to determine medical necessity
  • Escalate complex cases to Medical Directors and request additional documentation as needed
  • Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
  • Liaise with internal departments to resolve eligibility, benefits, or service issues
  • Participate in discharge planning for members transitioning from acute, long-term, or residential care
  • Conduct audits and support quality improvement initiatives
  • Provide training and mentorship on UM protocols and workflows
  • Maintain relationships with community providers and service organizations
  • Ensure compliance with organizational policies, clinical standards, and federal/state regulations
  • Perform other nursing-related duties as assigned

CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS
  • Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state
  • Graduation from an accredited nursing program
  • Minimum 5 years of direct patient care experience
  • Proficiency with Microsoft Office, EHR systems, and UM software
  • Strong clinical knowledge, communication, and organizational skills
  • No suspension, exclusion, or debarment from federal healthcare programs

PREFERRED QUALIFICATIONS
  • 2+ years of utilization review or case management experience in managed care
  • Oregon residency and license
  • Bilingual or translation skills a plus
  • Experience with quality improvement audits and diverse team collaboration
  • Ability to work independently in fast-paced environments
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
BENEFITS
  • Salary is dependent on skills, experience, and education
  • Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
  • Medical, dental, and vision insurance
  • 401(k) with company match (fully vested immediately)
  • Company-sponsored life insurance and additional benefits
  • Fitness reimbursement program
  • Tuition reimbursement and more

Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.

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