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Utilization Reviewer Jobs in Remote, OR (NOW HIRING)

Enterprise Engineering

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 ...

SOSi

Data Scientist

OR

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

SOSi

Senior Data Scientist

Myrtle Point, OR

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

SOSi

Senior Data Scientist

OR

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

SOSi

Senior 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.

SOSi

Data Scientist

Myrtle Point, OR

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

SOSi

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.

Aviva Health

Clinical Quality Manager

Roseburg, OR

$50.61 - $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 ...

BGIS

Be Seen First

Commercial HVAC Field Technical Support Specialist

OR · On-site

$35 - $45/hr

... and utilization of specific system tools ensuring timely, safe, and effective solutions. The ... Reviews and verifies accuracy of all compliance related data submitted from client business groups ...

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 ...

Aviva Health

Clinical Quality Manager

Roseburg, OR · On-site

$50.61 - $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 ...

Aviva Health

Clinical Quality Manager

Roseburg, OR · On-site

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 ...

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Showing results 21-40

All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Remote, OR

Utilization Reviewer information

See Remote, OR salary details

$31K

$38K

$44K

How much do utilization reviewer jobs pay per year?

As of Aug 7, 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 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 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 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.
More about Utilization Reviewer jobs
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:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Remote, OR as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 12% Part Time, and 5% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $37,955 per year, or $18.2 per hour.

UM Nurse

Enterprise Engineering

OR • Remote

Contractor

Re-posted 27 days ago

Job description

Job Title: UM Nurse (California License) – Must be licensed in California- Remote Opportunity

Work Hrs: (8am – 5pm PDT) would like to include evening, weekend and holiday coverage.

3 month contract plus

Remote Opportunity


Ready to Hire ASAP.

JD: The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive the services and resources required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient-centered care across the care continuum.

This position is not patient facing, they will be reviewing patient records and providing recommendations.

Role and Responsibilities

  • Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
  • 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 specific guidelines
  • Collaborate with the Medical Director to ensure the integrity of adverse determination notices based on the quality standards for adverse determinations
  • Ensure discharge planning is timely and appropriately communicated to the transition of care teams, when applicable.
  • Meet or exceed productivity targets set forth
  • Serve as a resource to non-clinical team members when applicable

Qualifications and Education Requirements

  • Associate's degree in Nursing, preferred
  • Minimum 2 years of experience in medical management clinical functions.
  • UM Reviewer in patient experience required
  • Working knowledge of MCG, InterQual, and NCQA standards
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About Enterprise Engineering

Sourced by ZipRecruiter

Our team is composed of architects and application experts skilled in Open Banking and Digital Transformation. Financial Data is in our DNA, and for years we have been helping our clients design, develop and deploy modern, innovative solutions bringing the greatest value to our clients and their business. If you have a constant thirst for emerging technology and a passion for pushing the needle towards excellence, you might be just like us. Life at EEI At EEI, our cultural pillars have been and continue to be a collaborative work environment that cultivates teamwork, mentoring, knowledge sharing, individual and team development. We are a humble bunch that cares for the personal and professional wellbeing of our clients and coworkers and support a healthy work life balance. Do you share our values?

Industry

It services

Company size

51 - 200 Employees

Headquarters location

NY, US

Year founded

1995

Social media

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