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

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 ...

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 ...

Host Healthcare

RN - Emergency Room

Coos Bay, OR · On-site

$890/wk

S. with an immediate option for this RN position in Coos Bay, OR. Sign-up here to submit your ... Reviews FROM REAL HOST HEALTHCARE TRAVELERS: "Host is the best travel agency. We have been using ...

Host Healthcare

RN - Medical-Surgical

Gold Beach, OR · On-site

$890/wk

S. with an immediate option for this RN position in Gold Beach, OR. Sign-up here to submit your ... Reviews FROM REAL HOST HEALTHCARE TRAVELERS: "Host is the best travel agency. We have been using ...

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

Utilization Review Rn information

See Remote, OR salary details

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$42

$68

How much do utilization review rn jobs pay per hour?

As of Jul 14, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, 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.

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 Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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:
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Utilization Review Rn jobs near you

MDS Coordinator (Registered Nurse/RN)

Life Care Center of Coos Bay

Coos Bay, OR • On-site

$35.25 - $42.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description



Benefits(full-time):· Continuing Education Credits (CEUs) and state license reimbursement (only add if it is budgeted for role, mainly rehab, check with ED for RN/LPN)· Flexible scheduling (only add if the role has flexible scheduling)· Student loan repayment (only if ED approved)· Mileage Reimbursement (McMinnville and for any other facility that has it)· Opportunities for career advancement and upward mobility into leadership roles· 401(k) retirement plan with company match· Vacation, six holidays, one personal day, and sick leave that begins accruing on day one· Life insurance, short/long term disability· Medical, Dental, Vision, Health Savings AccountsSetting & Population ServedLife Care Centers of America facilities operate as?Skilled Nursing Facilities (SNFs)?that provide:· Long term care?for residents who require ongoing skilled support and compassionate daily assistance· Short term, sub-acute rehabilitation?for patients recovering from surgery, illness, or injury· Collaborative care?through an interdisciplinary team approach with nursing, therapy, and medical staff working together· A diverse patient population?including individuals with orthopedic, neurological, cardiopulmonary, and post-acute needsPatient mix varies slightly by facility. As a therapy professional, you will help patients achieve functional progress and improve quality of life within a supportive, patient-centered environment.                 
Position Summary

The RN MDS Coordinator coordinates and assists with completion and submission of accurate and timely interdisciplinary MDS Assessments, CAAs, and Care Plans according to CMS RAI Manual Regulations and in accordance with all applicable laws, regulations, and Life Care standards.

Education, Experience, and Licensure Requirements
  • Associate’s or bachelor’s degree in nursing from an accredited college or university
  • Currently licensed/registered in applicable State. Must maintain an active Registered Nurse (RN) license in good standing throughout employment.
  • Two (2) years’ nursing experience. Geriatric nursing experience preferred.
  • CPR certification upon hire or obtain during orientation. CPR certification must remain current during employment.
Specific Job Requirements
  • Advanced knowledge in field of practice
  • Make independent decisions when circumstances warrant such action
  • Knowledgeable of practices and procedures as well as the laws, regulations, and guidelines governing functions in the post acute care facility
  • Implement and interpret the programs, goals, objectives, policies, and procedures of the department
  • Perform proficiently in all competency areas including but not limited to: patient rights, and safety and sanitation
  • Maintains professional working relationships with all associates, vendors, etc.
  • Maintains confidentiality of all proprietary and/or confidential information
  • Understand and follow company policies including harassment and compliance procedures
  • Displays integrity and professionalism by adhering to Life Care’s Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training
Essential Functions
  • Coordinate and assist with completion and submission of interdisciplinary, accurate, and timely MDS Assessments, CCAs, and Care Plans according to CMS RAI Manual Regulations
  • Report any changes in a patient’s condition identified by the MDS Assessment to the DON
  • Provide education to direct care associates regarding updates or changes to the CMS RAI Manual or Skilled Nursing Facility Regulations that impact documentation
  • Assist with review of the Interdisciplinary Comprehensive Care Plan
  • Review Final Validation Reports and attest that all assessments have been completed and accepted into the CMS QIES system prior to billing and notify the Business Office when assessments are not ready to bill
  • Review CMS Reports to identify assessments completed or submitted late and develop systems and processes to prevent reoccurrence
  • Attend and participate in the Daily PPS Meeting, Monthly Triple Check, and other meetings upon request
  • Perform functions of a staff nurse as required
  • Exhibit excellent customer service and a positive attitude towards patients
  • Assist in the evacuation of patients
  • Demonstrate dependable, regular attendance
  • Concentrate and use reasoning skills and good judgment
  • Communicate and function productively on an interdisciplinary team
  • Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
  • Read, write, speak, and understand the English language

An Equal Opportunity Employer

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