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Utilization Review Jobs in Remote, OR (NOW HIRING)

Aviva Health

Clinical Quality Manager

Roseburg, OR · On-site

$38.83 - $61.85/hr

This individual will review data, evaluate trends, and compare with benchmark measures. The ... Identify and prioritize key quality and utilization initiatives critical for the success of ...

Koerber

Senior Sales Operations Coordinator

OR · Remote

Coordinate executive approval reviews, pricing reviews, risk assessments, compliance approvals, and ... Monitor proposal workload, resource utilization, bid cycle times, and overall process effectiveness ...

International Benefits Administrators

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Client Relationship Manager

OR · On-site

$80K - $85K/yr

Analyze utilization, financial, service, and operational performance to identify trends, emerging ... annual reviews. Issue Resolution: Own the coordination of client-facing issues across internal ...

Lumen Technologies

Sr Lead Site Reliability Engineer

OR · Remote

$58.25 - $77.50/hr

Drive initiatives to improve latency, throughput, and resource utilization. Monitoring ... To review Lumen's Global Employment Applicant and Talent Community Privacy Notice, please visit:

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Utilization Review information

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$42

$68

How much do utilization review jobs pay per hour?

As of Sep 7, 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 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, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

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 August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 72% Physical, 2% Hybrid, and 26% Remote job distribution, with an average salary of $87,860 per year, or $42.2 per hour.

Clinical Quality Manager

Aviva Health

Roseburg, OR • On-site

$38.83 - $61.85/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago

Aviva Health rating

6.7

Company rating: 6.7 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

Job description

Please note that this is not a remote opportunity. Position is located on-site with some capacity for hybrid work.
Who We Are:
Aviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families. Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.
Benefits Include:
  • Monday - Friday Scheduling
  • Paid Holidays
  • PTO
  • Comprehensive Medical, Dental, and Vision Coverage
  • 403(b) Retirement with Employer Match
  • Training and professional development opportunities
  • Work-life balance as a Blue Zones participant

Position Purpose:
Under the direction of the VP of Infrastructure Optimization and the Chief Medical Officer, the Clinical Quality Manager is instrumental in the design, measurement/monitoring, implementation, and evaluation of actions to improve patient care. Primary focus for the Clinical Quality Manager is to lead the department in the quality improvement process and all associated quality programs. The Clinical Quality Manager collaborates with providers, other clinical departments and operations to establish best practices to ensure optimal outcomes for patients. Patient records maybe be reviewed for but not limited to audits, quality initiatives, performance improvement, work group initiatives, and CCO and other health plan metrics.
This individual will review data, evaluate trends, and compare with benchmark measures. The Clinical Quality Manager may recommend actions based on the review and participate in the actions taken to improve patient care on an individual or program level initiative(s). The Clinical Quality Manager serves as a resource to all staff regarding the quality and performance improvement processes and shall be responsible for oversight of all state and federal quality-related audits.
Essential Functions:
  • Manages the implementation, planning, designing and successful completion of the quality improvement program
  • Provides education to clinical staff on process improvement and related topics as it relates to quality improvement and metrics
  • Responsible for leading care gap closures through Quality Improvement Interventions - UDS & Metric measures
  • Responsible for maintaining or improving performance upon contractual and nationally required quality performance metrics, including HEDIS and customized state measures. Oversight of external contractors such as HEDIS to move towards a value-based payment model
  • Identify and prioritize key quality and utilization initiatives critical for the success of performance-based payment programs
  • Prepare and present reports and updates at internal and external provider related contracted local, state and federal program requirements
  • Assist Residency Program with Quality Improvement Projects
  • Analyzing data utilizing risk stratification tools per PCPCH requirements to maintain 5-star accreditation standards.
  • Leads Patient Center Primary Care Home program ensuring requirements are met
  • Responsible for leading process improvement efforts with clinical and non-clinical teams
  • Leads the development of new programs and protocols that improve patient care delivery
  • Monitors clinic practice efforts to ensure compliance with internal and external standards, set by local, state and federal programs.
  • Tracks, trends, monitors and acts on outcomes to include identification of corrective actions that may be needed
  • Oversees and is responsible for all state and federal quality-related audits
  • Run PDSA cycles for identified care caps and projects

Qualifications:
  • RN, BSN, LPN or other Clinical Degree preferred; or an equivalent combination of education, training, and experience to perform the tasks required of the position
  • CPHQ certification preferred
  • At least 2 years of experience in a clinical quality, quality assurance or risk management in a health care setting. Experience in a federally qualified health center or community health care setting preferred
  • Experience with UDS and CCO metrics strongly preferred
  • Patient-centered medical home (PCMH) or patient-center primary care home (PCPCH) experience strongly preferred; Population health experience is a plus

Ready to join our team? Apply now and take the next step in your career.
Aviva Health is an Equal Opportunity Employer
We are committed to fostering a diverse and inclusive workplace where all qualified applicants receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.
Aviva Health is a Drug-Free Workplace
To ensure a safe and secure environment for our employees and patients, Aviva Health maintains a drug-free workplace. All employment offers are contingent upon passing a drug screening and a criminal background check. Compliance with these policies is required throughout employment.

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