Umpqua Health is a healthcare organization dedicated to serving the residents of Douglas County, Oregon, through a range of services, including physical, behavi
Utilization Review Nurse
Location
Oregon
Posted
1 day ago
Salary
$85K - $105.3K / year
Seniority
Senior
Job Description
Utilization Review Nurse
Umpqua Health
• 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
Job 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
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