Utilization Review Nurse

Umpqua Health

Utilization Review Nurse evaluating medical necessity and authorizing care for Umpqua Health members. Coordinating transitions, audits, and regulatory compliance across Oregon’s integrated healthcare network.

Posted 8/5/2026full-timeRoseburg • Oregon • 🇺🇸 United StatesMid-LevelSenior💰 $85,000 - $105,340 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical assessments, utilization management, and compliance with healthcare regulations. Proven ability to collaborate with interdisciplinary teams and provide mentorship in care transitions and quality improvement initiatives.

Highest-signal resume keywords

Active RN LicenseUtilization Management SoftwareClinical AssessmentsQuality Improvement AuditsPatient Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentsUtilization ManagementPatient CareQuality ImprovementCase Management

Soft Skills

Communication SkillsOrganizational SkillsCollaborationMentorship

Tools & Technologies

Microsoft OfficeEHR Systems

Certifications & Qualifications

Active RN License (BSN or MSN)

Industry Keywords

Managed CareFederal Healthcare ProgramsOregon ResidencyDischarge PlanningInterdisciplinary Teams

About the role

Key responsibilities & impact

Perform clinical assessments and prior authorizations to determine medical necessity
Escalate complex cases to Medical Directors and request additional documentation
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 utilization management 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

Requirements

What you’ll need

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 utilization management software
Strong clinical knowledge, communication, and organizational skills
No suspension, exclusion, or debarment from federal healthcare programs
Preferred: 2+ years of utilization review or case management experience in managed care
Oregon residency and license preferred
Bilingual or translation skills are a plus
Experience with quality improvement audits and diverse team collaboration
Ability to work independently in fast-paced environments
Availability Monday through Friday, 8:00 a.m. to 5:00 p.m. PST
Ability to travel onsite to Roseburg, Oregon, as needed
Must be authorized to work for a U.S. employer without restriction and without employer sponsorship

Benefits

Comp & perks

Vacation PTO
Sick leave
Federal holidays
Birthday leave
Medical, dental, and vision insurance
401(k) with company match, fully vested immediately
Company-sponsored life insurance
Fitness reimbursement program
Tuition reimbursement
Professional development opportunities
Mentorship and clear career pathways
Flexible work and work/life balance support