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

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

Enterprise Engineering

Be Seen First

Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Concurrent Utilization Review (UR) Nurse Remote Opportunity Contract to Hire Must be licenses in ... Registered Nurse (RN) with an active, unrestricted California nursing license required; BSN ...

Evergreen Family Medicine

Registered Nurse (RN)

Roseburg, OR · On-site

$39.30 - $50.92/hr

Registered Nurse (RN) Evergreen Family Medicine is committed to providing excellent care for your ... Participates and promotes the economical utilization of supplies. * Minimizes non-productive time ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

Aviva Health Registered Nurse Aviva Health is a dynamic and mission-driven federally qualified ... Reviews patient history, medication list, diagnostics, and outside records to implement an ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

The Registered Nurse is to work as part of the patient care team in providing high quality ... Reviews patient history, medication list, diagnostics, and outside records to implement an ...

Aviva Health

Registered Nurse

Sutherlin, OR

The Registered Nurse is to work as part of the patient care team in providing high quality ... Reviews patient history, medication list, diagnostics, and outside records to implement an ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

$39.82 - $48.08/hr

The Registered Nurse is to work as part of the patient care team in providing high quality ... Reviews patient history, medication list, diagnostics, and outside records to implement an ...

US Navy

Registered Nurse

Coquille, OR

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Sutherlin, OR

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Lakeside, OR

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

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

Utilization Review Rn information

See Remote, OR salary details

$21

$42

$68

How much do utilization review rn jobs pay per hour?

As of Jun 21, 2026, the average hourly pay for utilization review rn in Remote, OR is $42.24, according to ZipRecruiter salary data. Most workers in this role earn between $33.37 and $48.51 per hour, depending on experience, location, and employer.

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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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.
What are the most commonly searched types of Utilization Review Rn jobs in Remote, OR? The most popular types of Utilization Review Rn jobs in Remote, OR are:
What are popular job titles related to Utilization Review Rn jobs in Remote, OR? For Utilization Review Rn jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Remote, OR look for? The top searched job categories for Utilization Review Rn jobs in Remote, OR are:
What cities near Remote, OR are hiring for Utilization Review Rn jobs? Cities near Remote, OR with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Remote, OR as of June 2026, with employment types broken down into 88% Full Time, 9% Part Time, and 3% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $87,860 per year, or $42.2 per hour.
Utilization Review Nurse

Utilization Review Nurse

Umpqua Health

Roseburg, OR • On-site, Remote

$85K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 18 days ago

Job description

UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, 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 Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
  • Perform clinical assessments and prior authorizations to determine medical necessity
  • Escalate complex cases to Medical Directors and request additional documentation as needed
  • Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
  • Liaise with internal departments to resolve eligibility, benefits, or service issues
  • Participate in discharge planning for members transitioning from acute, long-term, or residential care
  • Conduct audits and support quality improvement initiatives
  • Provide training and mentorship on UM protocols and workflows
  • Maintain relationships with community providers and service organizations
  • Ensure compliance with organizational policies, clinical standards, and federal/state regulations
  • Perform other nursing-related duties 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
  • Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state
  • Graduation from an accredited nursing program
  • Minimum 5 years of direct patient care experience
  • Proficiency with Microsoft Office, EHR systems, and UM software
  • Strong clinical knowledge, communication, and organizational skills
  • No suspension, exclusion, or debarment from federal healthcare programs

PREFERRED QUALIFICATIONS
  • 2+ years of utilization review or case management experience in managed care
  • Oregon residency and license
  • Bilingual or translation skills a plus
  • Experience with quality improvement audits and diverse team collaboration
  • Ability to work independently in fast-paced environments
SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
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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