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Supervisor Utilization Review Remote Jobs in Oregon

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

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

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site +1

$80K - $94K/yr

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

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Remote Medical Director, Inpatient Medicare

OR · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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Supervisor Utilization Review Remote information

What does a supervisor utilization review remote do?

A Supervisor Utilization Review (Remote) oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients—often for insurance or healthcare organizations. This role ensures that utilization review processes comply with regulatory requirements and organizational standards, while also guiding and supporting staff in their daily activities. Working remotely, the supervisor collaborates with clinicians, case managers, and other stakeholders to facilitate quality patient care and manage healthcare costs. The supervisor may also handle escalated cases and ensure timely completion of reviews.

What are the key skills and qualifications needed to thrive as a supervisor utilization review remote?

To thrive as a Supervisor Utilization Review Remote, you need a solid background in clinical healthcare (often as an RN or similar), experience with utilization management, and knowledge of regulatory guidelines. Familiarity with utilization review software, electronic medical records (EMR), and certifications like CCM or URAC accreditation are typically required. Strong leadership, critical thinking, and effective communication skills help in managing teams and collaborating across departments. These skills ensure efficient review processes, compliance with regulations, and high-quality patient care management in a remote setting.

What are some common challenges faced by remote supervisor utilization review professionals, and how can they be effectively managed?

Remote Supervisor Utilization Review professionals often encounter challenges such as coordinating with distributed team members, ensuring consistent application of review criteria, and maintaining clear communication with both clinical staff and payers. To manage these, it's important to establish regular virtual meetings, utilize secure and efficient digital platforms for case tracking, and foster a culture of transparency and accountability. Additionally, investing time in ongoing training and encouraging peer collaboration can help supervisors stay updated on regulatory changes and best practices.

What is the difference between Supervisor Utilization Review Remote vs Utilization Review Nurse?

AspectSupervisor Utilization Review RemoteUtilization Review Nurse
CredentialsRN license, possibly supervisor certificationRN license, certification in utilization review often preferred
Work EnvironmentRemote, supervisory role overseeing review teamsRemote or onsite, performing case assessments
Employer & IndustryHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

The Supervisor Utilization Review Remote typically oversees review teams and manages processes, requiring leadership skills and certifications. In contrast, Utilization Review Nurses focus on case assessments and approvals, often with similar certifications but less managerial responsibility. Both roles are essential in healthcare utilization management, often working remotely within the same industry.

What are popular job titles related to Supervisor Utilization Review Remote jobs in Oregon?

For Supervisor Utilization Review Remote jobs in Oregon, the most frequently searched job titles are:

What job categories do people searching Supervisor Utilization Review Remote jobs in Oregon look for?

The top searched job categories for Supervisor Utilization Review Remote jobs in Oregon are:

What cities in Oregon are hiring for Supervisor Utilization Review Remote jobs?

Cities in Oregon with the most Supervisor Utilization Review Remote job openings:

Supervisor Utilization Review Remote jobs near you

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 20 days ago

Job description

UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site 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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