Utilization Review Nurse Job at Umpqua Health, Roseburg, OR

dVFvSGpkaXlMRHhZdXVEUUl0K3o4T0w1dEE9PQ==
  • Umpqua Health
  • Roseburg, OR

Job Description

UTILIZATION REVIEW NURSE 

REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations. 

EMPLOYMENT TYPE: Full-Time, Exempt


 

About Umpqua Health

At Umpqua Health, we’re more than a healthcare organization—we’re a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.

POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.

ESSENTIAL JOB RESPONSIBILITIES
  • Perform clinical assessments and prior authorizations to determine medical necessity
  • Escalate complex cases to Medical Directors and request additional documentation as needed
  • Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
  • Liaise with internal departments to resolve eligibility, benefits, or service issues
  • Participate in discharge planning for members transitioning from acute, long-term, or residential care
  • Conduct audits and support quality improvement initiatives
  • Provide training and mentorship on UM protocols and workflows
  • Maintain relationships with community providers and service organizations
  • Ensure compliance with organizational policies, clinical standards, and federal/state regulations
  • Perform other nursing-related duties as assigned

CHALLENGES

  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast-paced and challenging company.


MINIMUM QUALIFICATIONS

  • 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

PREFERRED QUALIFICATIONS

  • 2+ years of utilization review or case management experience in managed care
  • Oregon residency and license
  • Bilingual or translation skills a plus
  • Experience with quality improvement audits and diverse team collaboration
  • Ability to work independently in fast-paced environments
SCHEDULE
Monday through Friday - 8:00am - 5:00pm ; standard business hours with flexibility to meet service timelines.

SALARY
Wage Band: $85,000- $105,340

BENEFITS
  • Salary is dependent on skills, experience, and education
  • 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
 

Why Umpqua Health?

We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.

Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.


 

Equal Opportunity

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.


 


 

Job Tags

Full time, Work at office, Local area, Immediate start, Remote work, Monday to Friday

Similar Jobs

Applebee's/IHOP

General Utility Job at Applebee's/IHOP

 ...50 pounds on a regular basis. 4. Able to respond in emergency situations to avoid imminent dangers to self and others. Wages: 1. Minimum Wage. Join the Team Behind a Groundbreaking Dining Experience! We're bringing together two iconic brandsApplebees and... 

Accentuate Staffing

Senior Accountant Job at Accentuate Staffing

Accentuate Staffing is seeking a high-performing Senior Accountant to support the accounting operations of a growing commercial real estate portfolio. This role is ideal for a hands-on professional who can manage day-to-day accounting activities while contributing to financial... 

Campbell County Health

PHYSICAL THERAPIST ASSISTANT | Home Health Job at Campbell County Health

 ...hospital policies and procedures. Other duties as assigned. This list is non-exhaustive. JOB QUALIFICATIONS Education Graduate of an accredited physical therapist assistant school. Licensure Must be licensed in, or be eligible to be licensed, in the State... 

Vail Resorts

Ticket Checker Job at Vail Resorts

 ...free pass(es) along with free ski and snowboard lessons, 40% retail discounts, the chance to grow through Epic Service - our leading training and development experience, and wellness benefits to fuel your success. Hiring for our seasonal positions occurs on a rolling... 

Langlade County (Antigo, Wisconsin)

Lead Child Welfare Professional Job at Langlade County (Antigo, Wisconsin)

 ...coverage or crisis support during complex, high-risk investigations or court proceedings. Essential Duties and Responsibilities To...  ...integrity, timely documentation, and compliance with state and federal funding guidelines. Assist in developing and updating...