ZipRecruiter

Log In

1

Utilization Review Jobs in Portland, OR (NOW HIRING)

Acentra Health, LLC

Review Assistant

Portland, OR · On-site

  • Medical

  • Retirement

  • PTO

The Review Assistant role is pivotal in streamlining the clinical review process by meticulously ... Proficiency in Microsoft Office applications and Excel, ensuring efficient utilization of essential ...

Adventist Health

Chart Auditor (Portland)

Portland, OR · On-site

$52.55 - $78.77/hr

Prior experience in utilization review, case management, coding, or clinical auditing: Preferred Licenses/Certifications: * Current licensed RN in the state of practice (RN), medical provider (MD ...

Tricehealthcare

Pharmacy - Pharmacist Inpatient

Portland, OR · On-site

$61.75 - $74.25/hr

... utilization review and program development, (5) clinical policy development and application, including Pharmacy and Therapeutics (P&T) Committee participation. The CPS is skilled at reviewing ...

previous page

Showing results 41-60

All JobsUtilization Review JobsUtilization Review Jobs in Portland, OR

Utilization Review information

See Portland, OR salary details

$22

$44

$73

How much do utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review 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.

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 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.

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.

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 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.

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

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

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

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

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

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

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

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

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Portland, OR as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $93,268 per year, or $44.8 per hour.

RN, Health Plan Care Manager

Adventist Health

Portland, OR • On-site

Other

Re-posted 6 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 243 frontline employees who took The Breakroom Quiz

158th of 887 rated healthcare providers

Job description

Job Title

Manages the development, implementation and evaluation of the cavitation care management service lines.

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Manages the development, implementation and evaluation of the cavitation care management service lines. 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.

Job Requirements

Education and Work Experience:

  • Bachelor's Degree in Nursing (BSN): Preferred
  • Nursing experience: Preferred

Licenses/Certifications:

  • Certified Case Manager (CCM): Preferred
  • 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. Perform and/or coordinate preventative care, wellness, and nutritional counseling to Members. 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.
  • Performs ongoing collaboration with staff to ensure a member's medical condition meets medical necessity criteria. 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.
  • 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.

What Adventist Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply