Remote RN Utilization and Benefit Management Lead

CareOregon, Inc.; Portland (OR); Remote; USD 127,000 - 155,000; Full time

Job summary

CareOregon, Inc. is seeking an RN Clinical Benefit Management Supervisor to lead a remote team of RNs in Prior Authorization and Benefit Review. You will oversee referrals, ensure regulatory compliance, and drive program improvements aligned with CareOregon’s mission.

The role includes staff development and occasional hands-on tasks to cover workloads. The ideal candidate will have an unrestricted Oregon RN license, 1–2 years in utilization management or prior authorization, and relevant

Qualifications

• Current, unrestricted Oregon RN license.
• Minimum 1 year utilization management or prior authorization RN experience.
• Preferred 1 year supervisory/lead experience or completion of Aspiring Leaders Program.
• 2 years utilization management or prior authorization RN experience.

Responsibilities

• Supervise RN team and set direction aligned with mission and values.
• Identify opportunities to improve program effectiveness and efficiency.
• Ensure authorizations comply with OHP, DMAP, Medicare rules and regulations.
• Develop policies, training materials, and keep staff updated on changes.

Skills

Utilization management

InterQual

OHP rules

CMS rules

Managed care

ICD-9 coding

CPT coding

Leadership

Training/supervision

Policy development

Education

Oregon RN license

Tools

SharePoint

QNXT

Workday

Job description

CareOregon, Inc. is seeking an RN Clinical Benefit Management Supervisor to lead a remote team of RNs in Prior Authorization and Benefit Review. You will oversee referrals, ensure regulatory compliance, and drive program improvements aligned with CareOregon’s mission.

The role includes staff development and occasional hands-on tasks to cover workloads. The ideal candidate will have an unrestricted Oregon RN license, 1–2 years in utilization management or prior authorization, and relevant