ZipRecruiter

Log In

1

Utilization Review Jobs in Remote, OR (NOW HIRING)

Umpqua Health

Director, Customer Care

Roseburg, OR · On-site

$113K - $132K/yr

Oversee the development, review, approval, and distribution of member-facing materials, including ... Partner with Utilization Management and Compliance teams to support grievance and appeal processes.

Umpqua Health

Director, Customer Care

Roseburg, OR · On-site

$113K - $132K/yr

Oversee the development, review, approval, and distribution of member-facing materials, including ... Partner with Utilization Management and Compliance teams to support grievance and appeal processes.

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

Reviews patient history, medication list, diagnostics, and outside records to implement an appropriate plan of care for the patient as defined by the provider. * Explains procedures and treatments to ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

Reviews patient history, medication list, diagnostics, and outside records to implement an appropriate plan of care for the patient as defined by the provider. * Explains procedures and treatments to ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

$39.82 - $48.08/hr

Reviews patient history, medication list, diagnostics, and outside records to implement an appropriate plan of care for the patient as defined by the provider. * Explains procedures and treatments to ...

Aviva Health

Registered Nurse

Sutherlin, OR · On-site

Reviews patient history, medication list, diagnostics, and outside records to implement an appropriate plan of care for the patient as defined by the provider. * Explains procedures and treatments to ...

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Jobs in Remote, OR

Utilization Review information

See Remote, OR salary details

$21

$42

$68

How much do utilization review jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for utilization review 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.

What jobs pay $10,000 a month without a degree?

Utilization Review roles typically do not pay $10,000 a month without relevant experience or certifications; most positions in this field pay lower salaries. High-paying jobs that can reach this level without a degree often include specialized sales, real estate, or entrepreneurship, but they usually require significant skills, networking, or business acumen. Achieving such income without a degree generally involves gaining expertise, certifications, or building a successful independent business.

What does a typical day look like for someone working in Utilization Review?

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 skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

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 the Utilization Review position, and why are they important?

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.

What is the least stressful healthcare job?

Utilization review is often considered a less stressful healthcare job because it typically involves reviewing medical cases and insurance claims in a predictable, office-based environment. It usually requires strong analytical skills and certification but involves less direct patient interaction and emergency situations compared to clinical roles.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare professional such as a registered nurse, licensed social worker, or physician completes relevant education and obtains certification in utilization review or case management. Gaining experience in healthcare settings and understanding insurance policies and medical coding can also improve job prospects. Certification programs like the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM) are often preferred by employers.
What are the most commonly searched types of Utilization Review jobs in Remote, OR? The most popular types of Utilization Review jobs in Remote, OR are:
What are popular job titles related to Utilization Review jobs in Remote, OR? For Utilization Review jobs in Remote, OR, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Remote, OR look for? The top searched job categories for Utilization Review jobs in Remote, OR are:
What cities near Remote, OR are hiring for Utilization Review jobs? Cities near Remote, OR with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Remote, OR as of June 2026, with employment types broken down into 100% Full Time. Highlights an 55% In-person, and 45% Remote job distribution, with an average salary of $87,860 per year, or $42.2 per hour.
Director, Customer Care

Director, Customer Care

Umpqua Health

Roseburg, OR • On-site

$113K - $132K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Job description

DIRECTOR, CUSTOMER CARE
ONSITE
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 Director of Customer Care is responsible for leading the strategy, development, and execution of all member-facing service, engagement, and communication functions at Umpqua Health. This role oversees the end-to-end member experience across inbound and outbound operations, including the Customer Care Call Center, Member Engagement operations, proactive outreach initiatives, and the full lifecycle of member communications from enrollment through disenrollment. The Director ensures Oregon Health Plan (OHP) members are informed of their rights, actively engaged as partners in their care, and supported through clear, culturally responsive, accessible, and compliant communication across all channels. Serving as the organizational champion for the member voice, this position is accountable for ensuring compliance with CCO contractual requirements while translating regulatory expectations into measurable service standards, scalable operational processes, and a culture grounded in equity, member advocacy, and service excellence.
ESSENTIAL JOB RESPONSIBILITIES
Customer Care & Call Center Operations
  • Lead the strategy, operations, staffing, training, and performance of the Customer Care Call Center, including inbound and outbound member services.
  • Ensure call center operations meet contractual service level standards, quality metrics, and accessibility requirements.
  • Oversee multilingual support services, interpreter access, and accommodations for members with hearing or speech impairments.
  • Manage call center technology platforms, quality assurance processes, call monitoring, scripting, and staff coaching initiatives.
  • Develop workforce and contingency staffing plans to support operational and contractual performance standards.

Member Engagement & Communications
  • Design and implement member engagement and outreach strategies across phone, mail, email, SMS, digital, and in-person channels.
  • Ensure member communications are culturally responsive, accessible, compliant, and written in plain language.
  • Oversee member outreach documentation and communication workflows within the Health Information System.
  • Partners with internal departments to align member engagement activities with care coordination, quality, and population health initiatives.
  • Support outreach and engagement efforts for vulnerable and high-risk member populations, including Medicare-eligible and dual-eligible members.

Member Rights, Compliance & Regulatory Oversight
  • Ensure compliance with Medicaid member rights, nondiscrimination requirements, language access standards, and member communication regulations.
  • Oversee the distribution and maintenance of required member notices, rights information, and accessibility resources.
  • Ensure staff are trained in member rights, grievances and appeals, interpreter services, fraud and abuse reporting, and enrollment/disenrollment processes.
  • Collaborate with Compliance, Privacy, and Regulatory teams to maintain compliant member-facing operations and materials.

Member Materials & Lifecycle Support
  • Oversee the development, review, approval, and distribution of member-facing materials, including handbooks, directories, notices, welcome materials, and educational content.
  • Ensure all materials meet readability, accessibility, translation, and regulatory requirements.
  • Support member enrollment, disenrollment, transitions of care, and onboarding communications.
  • Partner with internal teams to support enrollment reconciliation and member data accuracy processes.

Grievance & Appeals Support
  • Partner with Utilization Management and Compliance teams to support grievance and appeal processes.
  • Ensure members receive appropriate assistance with grievances, appeals, interpreter services, and access to support resources.
  • Support regulatory audits, investigations, and documentation requests related to member complaints and appeals.

Health Equity & Community Engagement
  • Promote culturally and linguistically appropriate services (CLAS) standards across all member touchpoints.
  • Use member demographic and engagement data to identify disparities and improve outreach strategies.
  • Build collaborative relationships with community organizations, Tribal partners, and culturally specific organizations to strengthen member engagement efforts.
  • Support member education regarding available community resources and care support services.

Cross-Functional Leadership & Performance Management
  • Partner with Quality, Care Coordination, Pharmacy, Provider Network, IT, Compliance, and other operational teams to support organizational goals and member experience initiatives.
  • Develop and monitor departmental performance metrics, dashboards, and reporting related to member engagement, satisfaction, accessibility, and operational performance.
  • Lead department participation in audits, readiness reviews, and compliance activities.
  • Oversee departmental policies, procedures, workflows, and continuous improvement initiatives.

People Leadership
  • Lead hiring, onboarding, training, coaching, performance management, and professional development for Customer Care staff.
  • Foster a high-performing, member-centered culture focused on accountability, service excellence, collaboration, and continuous improvement.
  • Provide leadership and support in a fast-paced, evolving environment while maintaining effective communication across teams and stakeholders.
  • Performs other duties and responsibilities as assigned to support the department and organizational operations.

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
  • Bachelor's degree in health administration, public health, marketing, communications, social work, or a related field.
  • 7+ years of progressive member services, member engagement, or member experience work in a healthcare or health plan setting; Medicaid/CCO experience strongly preferred.
  • 5+ years of direct accountability for a multi-channel member-facing Call Center or Member Services operation, including responsibility for service-level performance, workforce management, quality monitoring, and vendor/technology platforms.
  • 5+ years of people leadership experience, including managing managers or cross-functional teams.
  • Demonstrated experience operating a Grievance and Appeal System or equivalent member complaint/resolution function in a regulated managed care environment.
  • Proven ability to develop, execute, and measure multi-channel member engagement and outreach strategies in a highly regulated environment.
  • Strong analytical, communication, and project management skills with the ability to present to senior leadership, regulators, community partners, and Tribal leadership.
  • Valid driver's license, reliable transportation, and ability to maintain automobile insurance coverage meeting organizational requirements.
  • No suspension, exclusion, or debarment from participation in federal healthcare programs (e.g., Medicare/Medicaid).
  • Proficient computer skills, including Microsoft Office Suite; familiarity with call center telephony systems, CRM/member engagement platforms, and reporting or business intelligence tools.
PREFERRED QUALIFICATIONS
  • Master's degree preferred.
  • 7+ years of progressive member services, member engagement, or member experience work in a healthcare or health plan setting; Medicaid/CCO experience strongly preferred.
  • Demonstrated working knowledge of Oregon CCO contract requirements.
  • Direct experience developing and maintaining member-facing materials under OHA review, including Member Handbooks, Provider Directories, Welcome Packets, and member rights education materials.
  • Familiarity with OHA material submission and review processes, CLAS standards, REAL+D demographic data collection, and interpreter service requirements.
  • Experience with engagement platforms and digital outreach tools in a Medicaid setting.
  • Experience partnering with Federally Recognized Tribes, Tribal Organizations, Traditional Health Workers, and community-based organizations.
  • Experience considering the impacts of work across diverse communities and populations in operational or technical analysis.
  • Experience working within diverse teams and across varying communication styles.
  • Bilingual or biliterate skills (English/Spanish or other prevalent non-English language) preferred.

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $113,055- $132,840
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.

Apply