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Utilization Review Manager Jobs in Oregon (NOW HIRING)

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41.60K - $47K/yr

Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR ... Manage intake, tracking, and routing of prior authorization requests and supporting documentation.

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

POSITION PURPOSE The Utilization Management Nurse evaluates clinical service requests to ensure ... review or case management experience in managed care * Oregon residency and license * Bilingual or ...

Personify Health

$25 - $30/hr

... the Utilization Review Nurse will provide professional assessment and review for the medical ... Identify and refer potential cases to case management, wellness, chronic disease and Nurturing ...

Personify Health

$25 - $29/hr

Under the supervision of a registered nurse the Utilization Review Nurse will provide professional ... Identify and refer potential cases to case management, wellness, chronic disease and Nurturing ...

Personify Health

$25 - $29/hr

Under the supervision of a registered nurse the Utilization Review Nurse will provide professional ... Identify and refer potential cases to case management, wellness, chronic disease and Nurturing ...

Personify Health

$25 - $30/hr

... the Utilization Review Nurse will provide professional assessment and review for the medical ... Identify and refer potential cases to case management, wellness, chronic disease and Nurturing ...

Corrohealth

Coordinator, Utilization Management

OR · Remote

$19 - $20/hr

Review timely filing guidelines regarding the utilization management process. * Track and follow up with payers on pending authorizations to ensure timely responses. * Contact payer to elicit further ...

Performant

Medical Review Nurse II - SNF/MDS

OR · On-site +1

Experience with utilization management systems or clinical decision-making tools such as Medical ... Ability to manage multiple tasks including desk audits and claims review. * Must be able to ...

Curana Health, Inc.

Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...

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Utilization Review Manager information

See Oregon salary details

$41.2K

$96.2K

$177.1K

How much do utilization review manager jobs pay per year?

As of May 28, 2026, the average yearly pay for utilization review 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 are the key skills and qualifications needed to thrive as a Utilization Review Manager, and why are they important?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What are some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What does a Utilization Review Manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What are the most commonly searched types of Utilization Review jobs in Oregon? The most popular types of Utilization Review jobs in Oregon are:
What are popular job titles related to Utilization Review Manager jobs in Oregon? For Utilization Review Manager jobs in Oregon, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Oregon look for? The top searched job categories for Utilization Review Manager jobs in Oregon are:
What cities in Oregon are hiring for Utilization Review Manager jobs? Cities in Oregon with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Oregon as of May 2026, with employment types broken down into 97% Full Time, 1% Part Time, and 2% Contract. Highlights an 99% Physical, and 1% Hybrid job distribution, with an average salary of $96,225 per year, or $46.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

Umpqua Health

Winston, OR • On-site

$41.60K - $47K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

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

Job description

Utilization Review Specialist
HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470
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 Specialist supports Umpqua Health Alliance by coordinating the intake, review, processing, and completion of prior authorization requests within Medical Management. This role is responsible for ensuring accurate and timely handling of authorizations, maintaining compliance with regulatory and organizational requirements, supporting communication with providers and members, and assisting with workflow coordination to promote efficient utilization management operations.
ESSENTIAL JOB RESPONSIBILITIES
  • Support Utilization Review activities related to the prior authorization process.
  • Manage intake, tracking, and routing of prior authorization requests and supporting documentation.
  • Review requests for completeness and ensure appropriate routing for processing.
  • Communicate with healthcare providers to obtain additional information and resolve documentation issues.
  • Track prior authorization requests using established systems to ensure timely processing.
  • Support timely notification of prior authorization determinations.
  • Coordinate daily workflow and telephone coverage with team members.
  • Respond to internal and external inquiries regarding prior authorizations and route as appropriate.
  • Monitor and report on turnaround times to ensure compliance with requirements.
  • Maintain knowledge of applicable regulations, policies, and procedures.
  • Comply with organizational policies and applicable to federal, state, and local regulations.
CHALLENGES
  • Strong organizational skills with the ability to stay organized and productive in a remote, independent work environment
  • Proactive communication with internal and external stakeholders
  • Consistent ability to meet Oregon Health Plan (OHA) timeline and turnaround requirements
  • Ability to manage shifting priorities in a fast-paced environment
  • Ability to coordinate tasks and resources to meet operational goals and objectives
MINIMUM QUALIFICATIONS
  • High school diploma or equivalent.
  • Proficient computer skills, including Microsoft Office Suite (Word, Excel, Outlook, Teams), data entry, and internet research.
  • Experience using standard office equipment and systems, including keyboarding, web-based phone systems, and cloud-based document storage.
  • Ability to type a minimum of 45 words per minute with a high degree of accuracy.
  • Strong attention to detail.
  • No suspension, exclusion, or debarment from participation in federal healthcare programs (e.g., Medicare/Medicaid)
PREFERRED QUALIFICATIONS
  • 1+ years of experience in healthcare, managed care, medical coding, claims processing, or a related field
  • Knowledge of medical terminology, procedure codes, and diagnosis codes
  • Familiarity with Oregon Health Plan (OHP) and Coordinated Care Organizations (CCO), including applicable regulations (OAR, ORS, CFR, CMS, DMAP)
  • Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
  • Ability to meet deadlines while maintaining accuracy and attention to detail
  • Strong communication and customer service skills (written, verbal, and interpersonal)
  • Ability to work independently and collaboratively with sound judgment and confidentiality
  • Strong critical thinking and time management skills
  • Self-motivated with ability to follow policies, procedures, and workflows in a remote environment
  • Flexible and adaptable in a changing work environment
  • Willingness to learn and take on additional responsibilities as needed
  • Ability to work a standard schedule: Monday-Friday, 8:00 AM-5:00 PM PST
  • Experience working in diverse teams and with varied communication styles
  • Experience considering the impact of work on diverse communities, including communities of color
  • Bilingual or translation skills preferred

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band : $41,600- $47,000
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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