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Utilization Review Rn Jobs in Portland, OR (NOW HIRING)

Providence Medical Group

RN - Clinic

Beaverton, OR · On-site

Clinical Documentation Specialist RN The Clinical Documentation Specialist RN is responsible for ... plan utilization management and care management teams. Retrospective reviews of treatments to ...

Moda Health

RN Care Coordinator

Portland, OR

$71K - $89K/yr

... and maintain RN audit scores at or above the 90% benchmark. * Applies clinical expertise and ... Utilization Review and Service Authorizations for members of assigned employer groups. * Consults ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Portland, OR

Utilization Review Rn information

See Portland, OR salary details

$22

$44

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How much do utilization review rn jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for utilization review rn in Portland, OR is $44.84, according to ZipRecruiter salary data. Most workers in this role earn between $35.43 and $51.49 per hour, depending on experience, location, and employer.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Portland, OR?

The most popular types of Utilization Review Rn jobs in Portland, OR are:

What are popular job titles related to Utilization Review Rn jobs in Portland, OR?

For Utilization Review Rn jobs in Portland, OR, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Portland, OR look for?

The top searched job categories for Utilization Review Rn jobs in Portland, OR are:

What cities near Portland, OR are hiring for Utilization Review Rn jobs?

Cities near Portland, OR with the most Utilization Review Rn job openings:

Infographic showing various Utilization Review Rn job openings in Portland, OR as of September 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $93,268 per year, or $44.8 per hour.

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

Portland, OR • On-site

Adventist Health
Non-Profits • 10K+ employees
Learn more about Adventist Healthexternal

$114K - $171K/yr

Full-time

Posted 19 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 247 frontline employees who took The Breakroom Quiz

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.
About Us
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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