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Therapy Utilization Review Jobs in Remote, OR (NOW HIRING)

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 ... Licensed Marriage and Family Therapist (LMFT) * Registered Nurse (RN) with Behavioral Health ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · Remote

$80K - $94K/yr

UTILIZATION REVIEW CLINICIAN REMOTE Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Licensed Marriage and Family Therapist (LMFT) * Registered Nurse (RN) with Behavioral Health ...

All JobsTherapy Utilization Review JobsTherapy Utilization Review Jobs in Remote, OR

Therapy Utilization Review information

See Remote, OR salary details

$15

$31

$53

How much do therapy utilization review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for therapy utilization review in Remote, OR is $31.91, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.58 per hour, depending on experience, location, and employer.

What is the difference between Therapy Utilization Review vs Speech-Language Pathologist?

AspectTherapy Utilization ReviewSpeech-Language Pathologist
CredentialsTypically requires healthcare or insurance-related certificationsRequires a master's degree in speech-language pathology and state licensure
Work EnvironmentInsurance companies, healthcare organizations, or utilization review departmentsHospitals, clinics, schools, or private practice
Industry UsageFocuses on evaluating therapy necessity and coverageProvides direct therapy services to patients with speech or language disorders

While Therapy Utilization Review involves assessing the necessity of therapy services for insurance coverage, Speech-Language Pathologists provide direct patient care. Both roles require healthcare knowledge, but they differ in focus: one is review-based, the other is clinical service delivery.

What are some common challenges faced by professionals in therapy utilization review, and how can they be managed?

One of the main challenges in Therapy Utilization Review is balancing the clinical needs of patients with insurance guidelines and organizational policies. Professionals often need to make difficult decisions about treatment approvals while communicating effectively with both therapists and insurance providers. Staying current on clinical guidelines, maintaining strong documentation skills, and developing firm but empathetic communication abilities can help manage these challenges. Collaboration with interdisciplinary teams is also essential to ensure patients receive appropriate care while meeting regulatory requirements.

What is therapy utilization review?

Therapy Utilization Review is a process used by healthcare organizations and insurance companies to evaluate the necessity, efficiency, and appropriateness of therapy services being provided to patients. This review ensures that treatments such as physical, occupational, or speech therapy are medically necessary and align with established guidelines. The goal is to optimize patient care while managing costs and preventing overuse or misuse of therapy services. Professionals in this role review patient records, treatment plans, and progress notes, often collaborating with therapists and other healthcare providers.

What are the key skills and qualifications needed to thrive as a therapy utilization review specialist?

To thrive as a Therapy Utilization Review specialist, you need a solid background in clinical therapy practice (such as physical, occupational, or speech therapy), often supported by licensure and clinical experience. Familiarity with medical review software, electronic health records (EHRs), and utilization management systems is typically required, along with knowledge of insurance guidelines and regulatory standards. Strong analytical thinking, attention to detail, and clear communication skills help professionals effectively assess treatment plans and collaborate with both providers and payers. These skills and qualities are essential for ensuring that patients receive medically necessary, cost-effective therapy while maintaining compliance with regulations.
What are popular job titles related to Therapy Utilization Review jobs in Remote, OR? For Therapy Utilization Review jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Therapy Utilization Review jobs in Remote, OR look for? The top searched job categories for Therapy Utilization Review jobs in Remote, OR are:
Therapy Utilization Review jobs near you
Infographic showing various Therapy Utilization Review job openings in Remote, OR as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $66,371 per year, or $31.9 per hour.

Utilization Review Clinician

Umpqua Health

Roseburg, OR • On-site, Remote

$80K - $94K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

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 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 Review Clinician (URC) performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.
ESSENTIAL JOB RESPONSIBILITIES
Behavioral Health Utilization Management
  • Evaluate behavioral health and substance use disorder services to determine medical necessity, level of care, benefit eligibility, and compliance with established clinical guidelines.
  • Review behavioral health, Health-Related Social Needs (HRSN), and Flexible Services requests for appropriateness and coverage determination.
  • Conduct prospective, concurrent, and retrospective reviews, including inpatient behavioral health reviews, discharge planning, and transitions of care.
  • Apply clinical judgment and evidence-based criteria to make utilization decisions and identify cases requiring Medical Director review.
  • Request and evaluate additional clinical information from providers and members to support timely and accurate determinations.
  • Complete appeal reviews in collaboration with the Grievance and Appeals team.

Care Coordination and Member Support
  • Collaborate with care management teams, providers, and internal departments to support integrated behavioral and physical healthcare services.
  • Advocate for members by promoting access to timely, effective care in the least restrictive and most appropriate setting.
  • Support transitions from inpatient, residential, acute care, and Oregon State Hospital settings to community-based services.
  • Identify barriers to care and support solutions that promote continuity of services and improved outcomes.

Provider and Community Engagement
  • Partner with behavioral health providers and healthcare teams regarding treatment plans, level of care, and utilization management processes.
  • Provide education and guidance to providers, members, and families regarding behavioral health benefits, services, and available resources.
  • Develop and maintain effective relationships with community providers and organizations.

Compliance and Quality Improvement
  • Maintain compliance with Umpqua Health policies, contractual requirements, and applicable state and federal regulations, including Oregon Administrative Rules (OAR), Oregon Health Plan (OHP), Medicare guidelines, and grievance and appeal requirements.
  • Maintain accurate, timely, and comprehensive clinical documentation in accordance with regulatory and organizational standards.
  • Conduct quality reviews and audits to identify opportunities for process improvement.
  • Meet departmental expectations for productivity, accuracy, quality, and turnaround times.

Additional Responsibilities
  • Collaborate with Third-Party Recovery and Customer Care teams regarding coverage, eligibility, and coordination of benefits.
  • Participate in clinical rounds, case reviews, and interdisciplinary discussions.
  • Provide training and support to new employees and cross-functional teams as needed.
  • Perform other duties and responsibilities 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
  • Current Oregon license to practice independently as one of the following:
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Professional Counselor (LPC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Registered Nurse (RN) with Behavioral Health certification (e.g., PMH-BC)
  • Certified Alcohol and Drug Counselor (CADC I) certification, at minimum.
  • Master's degree in Social Work, Counseling, Psychology, Nursing, or a related behavioral health field.
  • Two (2) to four (4) years of behavioral health, substance use disorder, addiction treatment, or care management experience.
  • Clinical knowledge of mental health and substance use treatment with the ability to assess treatment plans and medical necessity.
  • Eligible to participate in federal healthcare programs (no Medicare/Medicaid suspension, exclusion, or debarment).
  • Proficiency with Microsoft Office and standard computer systems.
  • Valid driver's license and proof of current automobile insurance.
  • Must not be suspended, excluded, or debarred from participation in federal health care programs (e.g., Medicare/Medicaid).
PREFERRED QUALIFICATIONS
  • Experience in Behavioral Health Utilization Management/Utilization Review, Case Management, or Managed Care.
  • Experience reviewing behavioral health services, including prior authorization, concurrent review, discharge planning, and care coordination for mental health and substance use disorders across inpatient, residential, partial hospitalization, or intensive outpatient (IOP) settings.
  • Knowledge of health plan benefits, community resources, electronic health records, and quality improvement processes.
  • Strong analytical, critical thinking, problem-solving, and organizational skills with the ability to manage multiple priorities independently in a fast-paced environment.
  • Demonstrated ability to collaborate effectively with providers, multidisciplinary teams, and diverse communities while maintaining cultural awareness, professionalism, confidentiality, and regulatory compliance.
  • Maintains current clinical knowledge and applicable certifications.
  • Experience evaluating the impact of work across diverse communities, including communities of color, in technical analysis.
  • Experience working in diverse team environments and across varying communication styles.
  • Bilingual translation skills are a plus.

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $80,470- $94,550
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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