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Utilization Manager Jobs in Oregon (NOW HIRING)

Mvphealthcare

Sub-Acute RN UM Reviewer - Medicare

OR · Remote

$69.38K - $92.28K/yr

At least 2 years of experience in utilization management of sub-acute Medicare reviews * Strong knowledge of sub-acute care, rehabilitation, and skilled nursing services * Proficiency in interpreting ...

New

Centene

Clinical Review Nurse - Concurrent Review

OR · Remote

$27.02 - $48.55/hr

Knowledge of utilization management processes preferred. License/Certification: * LPN - Licensed Practical Nurse - State Licensure required * RN - Registered Nurse - State Licensure and/or Compact ...

HealthEdge

Knowledge of CMS regulatory reporting for Utilization Management * Ability and willingness to delegate, guide and oversee work of team. * Excellent analytical, organizational, planning, verbal, and ...

HealthEdge

Utilization Management QA RN

Requirements: * 2+ years' experience in US Healthcare in utilization management and/or Quality Assurance review * HealthEdge HRCM, JIRA or Guiding Care experience is a plus Skills/Knowledge/Abilities ...

Guidehouse

OR

$68K - $113K/yr

Collaborate with Patient Access, Case Management, Utilization Management, Coding, and MidRevenue Cycle teams to resolve denials and prevent recurrence. * Research and apply payerspecific policies ...

Performant

Medical Review Nurse II - SNF/MDS

OR · On-site +1

Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. * Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 ...

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Utilization Manager information

See Oregon salary details

$41.2K

$96.2K

$177.1K

How much do utilization manager jobs pay per year?

As of May 30, 2026, the average yearly pay for utilization manager in Oregon is $96,225.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,900.00 and $115,800.00 per year, depending on experience, location, and employer.

What Is a Utilization Manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by Utilization Managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What does a Utilization Manager do?

A Utilization Manager is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their primary goal is to ensure that patients receive the right care at the right time while also controlling costs for hospitals, insurance companies, or healthcare organizations. Utilization Managers review patient records, coordinate with healthcare providers, and use clinical guidelines to make informed decisions about treatment approvals or denials. They play a key role in maintaining quality care and regulatory compliance.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
What are the most commonly searched types of Utilization jobs in Oregon? The most popular types of Utilization jobs in Oregon are:
What are popular job titles related to Utilization Manager jobs in Oregon? For Utilization Manager jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in Oregon look for? The top searched job categories for Utilization Manager jobs in Oregon are:
What cities in Oregon are hiring for Utilization Manager jobs? Cities in Oregon with the most Utilization Manager job openings:
What are popular job titles related to Utilization Manager jobs in OR? For Utilization Manager jobs in OR, the most frequently searched job titles are:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Oregon as of May 2026, with employment types broken down into 87% Full Time, 12% Part Time, and 1% Temporary. Highlights an 98% Physical, and 2% Hybrid job distribution, with an average salary of $96,225 per year, or $46.3 per hour.
Director UM Management Nurse

Director UM Management Nurse

Millennium Physician Group

Remote

Full-time

Posted 14 days ago

Millennium Physician Group rating

6.2

Company rating: 6.2 out of 10

Based on 57 frontline employees who took The Breakroom Quiz

688th of 864 rated healthcare providers

Job description

Job Description Summary

The UM Nurse Lead is responsible for conducting and overseeing clinical utilization management activities to ensure medically appropriate, high-quality, and cost-effective care for members. This role collaborates with healthcare providers, members, and operational leadership to promote quality outcomes, optimize member benefits, and support effective resource utilization particularly for complex medical cases.
The UM Nurse Lead serves as a subject matter expert within the department, supports regulatory and accreditation readiness, and may lead intradepartmental initiatives and team activities.

How will you make an impact & Requirements

Clinical Utilization Management

  • Conduct prospective, concurrent, and retrospective reviews for:
    • Inpatient admissions
    • Continued stay reviews
    • Outpatient services
    • Surgical and diagnostic procedures
    • Out-of-network services
    • Appropriateness of treatment setting
  • Apply evidence-based guidelines (e.g., MCG, InterQual), CMS regulations, medical policies, and industry standards to determine medical necessity.
  • Accurately interpret and apply member eligibility, benefits, contracts, and managed care products.
  • Ensure compliance with regulatory and accreditation standards (e.g., NCQA, URAC, CMS).

Collaboration & Care Coordination

  • Collaborate with providers and members to promote quality outcomes and cost-effective care.
  • Work closely with Regional Medical Directors for:
    • Interpretation of complex cases
    • Medical necessity clarification
    • Non-certification determinations (does not independently issue denials when physician review is required).
  • Facilitate care transitions across the healthcare continuum.
  • Refer treatment plans to clinical reviewers and/or Medical Directors as required.

Appeals & Compliance

  • Participate in the review and coordination of appeals for services denied.
  • Ensure documentation is complete, accurate, and compliant with internal policies and regulatory standards.
  • Facilitate accreditation readiness by understanding and correctly applying accrediting and regulatory requirements.

Leadership & Oversight

  • Serve as a clinical resource to team members.
  • Provide guidance on medical policy interpretation and UM processes.
  • Participate in or lead intradepartmental teams, projects, and quality improvement initiatives.
  • Identify trends in utilization patterns and contribute to performance improvement strategies.
  • Support staff training and onboarding activities as needed.

Qualifications

  • Current, active, unrestricted RN license in applicable state(s) or U.S. territory.
  • Associate's Degree in Nursing required; Bachelor's degree preferred.
  • Minimum of 5 years of:
    • Acute care clinical experience, or
    • Case management, utilization management, or managed care experience,
    • Or any combination of education and experience providing equivalent background.
  • Prior managed care or health plan/MSO experience strongly preferred.
  • Participation in the American Association of Managed Care Nurses (AAMCN) preferred.

Required Knowledge & Skills

  • Strong knowledge of:
    • Medical management processes
    • Medical necessity review criteria (MCG, InterQual)
    • Member contracts and benefit interpretation
    • Managed care products
  • Understanding of Medicare/Medicaid regulations.
  • Strong clinical judgment within RN scope of practice.
  • Excellent oral, written, and interpersonal communication skills.
  • Strong analytical, problem-solving, and facilitation skills.
  • Proficiency with EMRs, review platforms, and Microsoft Office applications.
  • Ability to manage multiple priorities in a fast-paced or remote environment.

What Millennium Physician Group employees say

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