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Utilization Care Manager Jobs in Portland, OR (NOW HIRING)

Pacs

Resident Care Manager

Forest Grove, OR

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Coordinate care with resident, care providers, facilities financial services, and third-party ...

Escondido Pa

Resident Care Manager

Forest Grove, OR · On-site

$75 - $95/hr

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Coordinate care with resident, care providers, facilities financial services, and third-party ...

PACS Group, Inc.

Resident Care Manager

Forest Grove, OR · On-site

$65 - $90/hr

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Coordinate care with resident, care providers, facilities financial services, and third-party ...

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All JobsUtilization Care JobsUtilization Care Manager JobsUtilization Care Manager Jobs in Portland, OR

Utilization Care Manager information

See Portland, OR salary details

$41.4K

$96.5K

$177.6K

How much do utilization care manager jobs pay per year?

As of Sep 5, 2026, the average yearly pay for utilization care manager in Portland, OR is $96,518.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,100.00 and $116,100.00 per year, depending on experience, location, and employer.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in Portland, OR?

For Utilization Care Manager jobs in Portland, OR, the most frequently searched job titles are:

What job categories do people searching Utilization Care Manager jobs in Portland, OR look for?

The top searched job categories for Utilization Care Manager jobs in Portland, OR are:

What cities near Portland, OR are hiring for Utilization Care Manager jobs?

Cities near Portland, OR with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you

Manager, Health Plan Care Management, Full Time, Day Shift

Adventist Health

Portland, OR • On-site

Full-time

Posted 9 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 246 frontline employees who took The Breakroom Quiz

163rd of 898 rated healthcare providers

Job description

Adventist Health Portland has been caring for East Portland since 1893, growing alongside the community we serve. Today, more than 2,300 employees are dedicated to whole-person care, mind, body and spirit, across our 302-bed medical center, emergency department, and network of clinics, urgent care, home care and hospice services. The Adventist Health Northwest Heart Center, located on our medical center campus, provides advanced cardiovascular care, bringing together expert providers, innovative treatments and compassionate support for patients across the region.

Job Summary:

Develops, implements and evaluates the services provided by care management department. Enhances the quality of member management by promoting continuity of care and cost effectiveness through whole person in-patient and out-patient management, care integration, case management, utilization review and care planning. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

Job Requirements:

Education and Work Experience:

  • Bachelor's Degree in nursing or equivalent combination of education/related experience: Required
  • Master's Degree: Preferred
  • Five years' nursing experience: Preferred
  • One year's leadership experience in a physician clinic, hospital department or health plan setting: Preferred
  • Certified Case Manager: Preferred

Licenses/Certifications:

  • Registered Nurse (RN) licensure in the state of practice: Required

Essential Functions:

  • Partners with internal and external physician advisors, as well as claims department and data management and analytics department to provide safeguards, processes and expected outcomes for the Health Plan's member population. Provides formal and informal education to physicians and the care management team to improve processes and outcomes related to utilization review, case management and compliance. Develops and maintains positive relationships with customers internal and external.
  • Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives. Communicates changes that could affect the discharge plan of care.
  • Manages communication related to discharge planning and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
  • Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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