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Utilization Review Jobs in Oregon (NOW HIRING)

P3 Health Partners

Concurrent Review RN

Salem, OR · On-site

$90K - $100K/yr

Perform telephonic and onsite utilization reviews, including prior authorization, concurrent review, and transition of care evaluations. * Review and approve services within scope of authority and ...

P3 Health Partners

Concurrent Review RN

Salem, OR · On-site

$90K - $100K/yr

Perform telephonic and onsite utilization reviews, including prior authorization, concurrent review, and transition of care evaluations. * Review and approve services within scope of authority and ...

P3 Health Partners

Concurrent Review RN

Salem, OR

$90K - $100K/yr

Perform telephonic and onsite utilization reviews, including prior authorization, concurrent review, and transition of care evaluations. * Review and approve services within scope of authority and ...

PacificSource

Utilization Management Clinician

Bend, OR · On-site

Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs. * Maintain contact with the inpatient facility utilization ...

PacificSource

Utilization Management Clinician

Bend, OR · On-site

Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs. * Maintain contact with the inpatient facility utilization ...

PacificSource

Utilization Management Clinician

Bend, OR · On-site

Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs. * Maintain contact with the inpatient facility utilization ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Oregon

Utilization Review information

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$22

$44

$72

How much do utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review in Oregon is $44.70, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $51.35 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

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 jobs in Oregon?

For Utilization Review jobs in Oregon, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Oregon look for?

The top searched job categories for Utilization Review jobs in Oregon are:

What cities in Oregon are hiring for Utilization Review jobs?

Cities in Oregon with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Oregon as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $92,985 per year, or $44.7 per hour.

Concurrent Review RN

P3 Health Partners

Salem, OR • On-site

$90K - $100K/yr

Other

Medical, Vision

Posted 4 days ago

P3 Health Partners rating

6.6

Company rating: 6.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Make an Impact Where Clinical Excellence Meets Care Coordination
Are you a clinically strong RN who thrives in a dynamic healthcare environment and enjoys collaborating across the continuum of care? P3 Health Partners is seeking a Concurrent Review RN to play a critical role in ensuring patients receive the right care, at the right time, and in the most appropriate setting.
In this role, you'll work closely with hospitals, physicians, specialists, care teams, and health plan partners to support appropriate utilization of healthcare resources, facilitate smooth care transitions, and improve patient outcomes. Your expertise will directly contribute to P3's commitment to the Quadruple Aim: improving health outcomes, enhancing the patient and provider experience, and reducing the cost of care.
What You'll Do
As a Concurrent Review RN, you'll leverage your clinical expertise and utilization management knowledge to evaluate medical necessity, coordinate care transitions, and collaborate with healthcare teams to ensure optimal patient care.
Key Responsibilities
  • Promote the mission, vision, and values of P3 Health Partners.
  • Perform telephonic and onsite utilization reviews, including prior authorization, concurrent review, and transition of care evaluations.
  • Review and approve services within scope of authority and escalate cases requiring additional review when appropriate.
  • Apply evidence-based review criteria, including:
    • Health plan benefits
    • CMS guidelines
    • Local and National Coverage Determinations (LCD/NCD)
    • InterQual and MCG criteria
  • Utilize clinical judgment to assess medical necessity, level of care, and appropriate service utilization.
  • Collaborate with hospitals, providers, and internal stakeholders to support discharge planning and care transitions.
  • Request and review additional clinical documentation to support utilization review decisions.
  • Escalate complex cases and medical necessity questions to the Medical Director as needed.
  • Coordinate care with physicians, specialists, emergency department personnel, patients, and families.
  • Partner with provider network teams and Medical Management departments to align care plans and support positive patient outcomes.
  • Educate providers and clinical staff regarding utilization management processes, criteria, and requirements.
  • Serve as a clinical resource and subject matter expert for non-clinical team members.
  • Identify opportunities to close care gaps and improve patient outcomes.
  • Accurately document all clinical reviews, communications, and decisions within designated systems.
What Makes You Successful
You are a highly skilled clinician with a strong understanding of utilization management, care coordination, and evidence-based decision making. You are comfortable working independently while building strong relationships across healthcare settings.
Core Competencies
  • Strong clinical knowledge of acute, post-acute, and transitional care management.
  • In-depth understanding of utilization management principles and medical necessity review processes.
  • Experience applying evidence-based criteria, including InterQual, MCG, and CMS guidelines.
  • Excellent communication skills with the ability to interact effectively with physicians, hospital personnel, patients, and families.
  • Strong critical thinking, assessment, and problem-solving abilities.
  • Ability to navigate complex or sensitive discussions regarding level of care and service authorization decisions.
  • Exceptional organizational skills with the ability to manage multiple priorities and deadlines.
  • Proficiency with Microsoft Office applications and medical management software platforms.
  • Ability to work independently while collaborating effectively within interdisciplinary teams.
  • Adaptability and commitment to continuous learning in an evolving healthcare environment.
Qualifications
Required
  • Graduate of an accredited School of Nursing.
  • Active Registered Nurse (RN) license in Oregon with the ability to obtain and maintain licensure in multiple states.
  • Minimum of four (4) years of clinical nursing experience.
  • Minimum of two (2) years of experience in a managed care, Medicare Advantage, or HMO environment.
  • Experience conducting medical necessity reviews and applying evidence-based clinical guidelines.
Preferred
  • Bachelor of Science in Nursing (BSN).
  • Previous Emergency Department (ED) experience.
  • Previous Intensive Care Unit (ICU) experience.
  • Experience in Case Management and/or Utilization Management.
  • Experience working with InterQual, MCG, CMS guidelines, and transitions of care programs.
Schedule Hours & Work Location
  • Monday - Friday, 8 AM - 5 PM PST
  • This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.

Salary Range: $90,000 - $100,000 annually
The posted salary range reflects P3 Health Partners' good-faith estimate for this role at the time of posting. Placement within the range will be based on qualifications, experience, education, geographic location, and internal equity considerations. In addition to base salary, eligible employees may have access to a comprehensive benefits package and other compensation opportunities.
Why Join P3?
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients. We are a physician-led organization relentless in our mission to overcome obstacles and positively disrupt the business of healthcare, transforming it from sickness care into wellness guidance.
As a Concurrent Review RN, you'll play an essential role in helping patients navigate the healthcare system while ensuring high-quality, evidence-based care. Your expertise will help improve outcomes, support providers, and ensure patients receive the appropriate care at every stage of their healthcare journey.
At P3, you'll collaborate with passionate healthcare professionals who are committed to innovation, teamwork, and delivering meaningful results. If you are passionate about your work, eager to have fun, and motivated to be part of a fast-growing organization where your contributions truly make a difference, we'd love to hear from you.
Join us in transforming healthcare and helping communities achieve better health outcomes.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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