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Utilization Reviewer Jobs in Remote, OR (NOW HIRING)

Clinical Pharmacist

Coos Bay, OR · On-site

$63.35 - $94.03/hr

Performs drug utilization review and determines the presence of medication-therapy problems by evaluation of medication orders in light of the information contained in the patient's record and ...

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UM Nurse

OR · Remote

Review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare criteria, Medicaid/Medi-cal criteria, Interqual, Milliman, or Health Plan ...

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

Data Scientist

OR · On-site +1

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

Data Scientist

OR · On-site

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

The contractor shall conduct quarterly reviews to track cost efficiency, assess system performance, and optimize analytic workflows through the Quarterly Cost & Resource Utilization Report.

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 ...

Showing results 21-40

Utilization Reviewer information

See Remote, OR salary details

$31K

$38K

$44K

How much do utilization reviewer jobs pay per year?

As of Sep 15, 2026, the average yearly pay for utilization reviewer in Remote, OR is $37,955.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.

What are popular job titles related to Utilization Reviewer jobs in Remote, OR?

For Utilization Reviewer jobs in Remote, OR, the most frequently searched job titles are:

What job categories do people searching Utilization Reviewer jobs in Remote, OR look for?

The top searched job categories for Utilization Reviewer jobs in Remote, OR are:

What cities near Remote, OR are hiring for Utilization Reviewer jobs?

Cities near Remote, OR with the most Utilization Reviewer job openings:

Infographic showing various Utilization Reviewer job openings in Remote, OR as of August 2026, with employment types broken down into 72% Full Time, and 28% Part Time. Highlights an 55% In-person, and 45% Remote job distribution, with an average salary of $37,955 per year, or $18.2 per hour.

Therapy Coordinator

Myrtle Point, OR • On-site

Reliant Rehabilitation
Health Care and Social Assistance • 5 - 10K employees

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 days ago


Reliant Rehabilitation rating

6.3

Company rating: 6.3 out of 10

Based on 45 frontline employees who took The Breakroom Quiz


Job description

Overview

#LI-KT1

Up to $10,000 Sign-On-Bonus

Why Join Reliant Rehabilitation?

Joining Reliant means becoming part of a team that makes a real difference in the lives of patients and residents across a variety of care communities. As one of the nation's largest contract therapy providers, Reliant offers unmatched clinical support, professional development, and growth opportunities.

Our leadership team began their careers as therapists, and we take pride in promoting from within. You'll be supported by a dedicated clinical team that provides ongoing training, proven protocols, and hands-on guidance - ensuring therapy is delivered effectively for patients and in full compliance to support our partners.

With operations in 44 states and more than 900 communities nationwide, Reliant can match your location, schedule, and career goals, wherever your path leads.

 

What We Offer:

            Competitive compensation packages

            Medical, dental, vision, and company-paid life insurance

            401(k) with employer match

            PTO Share and Buy-Back Programs

            Maternity and Paternity support program

            Continuing education, mentorship programs and clinical leadership development

            Tuition loan repayment assistance Program

            Flexible scheduling options

Responsibilities

Position Summary:

The Therapy Coordinator (TC) oversees the rehabilitation department to ensure resident needs are met while aligning with company financial goals and adhering to federal and state regulations. This role is responsible for achieving patient care, customer service, and financial objectives through strategic staff scheduling based on patient needs. The Therapy Coordinator maintains professional conduct and fosters positive relationships with clients and facility staff, representing Reliant Rehabilitation's commitment to quality care and service excellence. All duties are performed in accordance with Reliant Rehabilitation's policies and procedures.

Key Responsibilities:

            Assign patient scheduling and delegate responsibilities to staff as appropriate

            Coordinate departmental functions with other services to promote teamwork and operational efficiency

            Communicate effectively with facility administration regarding departmental goals, programs, risks, and achievements

            Participate in interdisciplinary meetings including utilization review, quality assurance, resident care conferences, admissions, department head meetings, and community education planning

            Ensure timely and accurate completion of Minimum Data Set (MDS) reporting

            Oversee accurate billing and documentation of services provided

            Maintain a valid state license (as applicable) and stay informed on professional and healthcare industry developments

            Understand and apply relevant billing models and treatment guidelines to deliver clinically appropriate care with measurable outcomes

            Adhere to infection control and environmental safety protocols within the facility

            Attend all required meetings, training, and assignments as directed

            Comply with the responsibilities outlined in the position description for the licensed discipline

            Demonstrate proficiency in reading, writing, speaking, and understanding English for effective communication and documentation

            Maintaining confidentiality as appropriate and ensuring compliance with the state practice act in the state(s) where you are licensed.

Qualifications

Qualifications/Licenses:

          Must hold a degree in Physical Therapy, Physical Therapist Assistant, Occupational Therapy, Occupational Therapy Assistant or Speech-Language Pathology from an accredited institution.

       (2) years of experience as a Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Occupational Therapy Assistant, Speech-Language Pathologist.

Please note rate range is an estimate and may vary based on skill set and location(s).

#LI-KT1

Employment Type: FULL_TIME

What Reliant Rehabilitation employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom


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About Reliant Rehabilitation

Sourced by ZipRecruiter

Reliant Rehabilitation is a leading provider in the healthcare industry, specifically in the sphere of rehabilitative services. Headquartered in Plano, Texas, US, the company operates across multiple locations around the country. Serving healthcare facilities since its establishment, Reliant Rehabilitation provides physical, occupational and speech therapy services. Their mission is to provide caring, high-quality, cost-effective therapy services across the continuum of care. Upholding core values of integrity, patient-focused, creativity, collaboration, and clinical excellence, they are committed to returning patients to levels of movement, function, and independence they never believed possible.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Plano, TX, US