Umpqua Health

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

Bachelor Degree5 yrs expEnglish

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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