Utilization Review Nurse

🔥 0 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $85k - $105.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Umpqua Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

Healthcare Insurance

Umpqua Health is a regional health plan and care organization serving Douglas County, Oregon. It operates a health plan and member services (including enrollment, benefits, nurse hotline, and care coordination) and runs a Rural Health Clinic (Newton Creek Clinic) offering primary care, behavioral health, urgent care and pharmacy support. The organization also manages provider contracting/credentialing, quality and compliance programs, community grants and health-related social needs initiatives.

📋 Description

• Evaluate clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members • Conduct prior authorizations and facilitate care coordination • Support safe transitions across care settings and ensure compliance with regulations • Collaborate with interdisciplinary teams and community providers to promote integrated, high-quality care • Maintain relationships with community providers and service organizations • Ensure compliance with organizational policies and clinical standards • Provide training and mentorship on UM protocols and workflows

🎯 Requirements

• Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state • Graduation from an accredited nursing program • Minimum 5 years of direct patient care experience • Proficiency with Microsoft Office, EHR systems, and UM software • Strong clinical knowledge, communication, and organizational skills • No suspension, exclusion, or debarment from federal healthcare programs • 2+ years of utilization review or case management experience in managed care (preferred) • Oregon residency and license (preferred) • Bilingual or translation skills a plus (preferred)

🏖️ Benefits

• 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