Remote RN – Utilization Management & Appeals

CareOregon, Inc.; Portland (OR); Remote; USD 102,000 - 125,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Paid time off

Job summary

CareOregon is seeking a Registered Nurse in Utilization Management I to support UM program functions within the Clinical Operations department. The role focuses on Benefit Management, Benefit Review, Appeals and Grievances, and Health Related Services, with decisions based on clinical criteria while managing medical expenses.

Remote work with preference for Oregon/SW Washington. The position offers a competitive hiring range and 5% bonus target.

Qualifications

• Current unrestricted Oregon RN license.
• Minimum 2 years RN experience or 1 year RN + 3 years in healthcare setting roles such as billing or coding.
• Healthcare utilization management experience preferred.

Responsibilities

• Communicate with members and providers professionally per state/federal requirements.
• Maintain confidential documentation and participate in quality management activities.
• Collaborate with Medical Directors to determine medical necessity for benefits.
• Assist with audits, system testing, and training of staff.

Skills

RN license knowledge

Healthcare documentation

Utilization management

Communication skills

HIPAA/privacy

Education

RN License (Oregon)

Tools

Microsoft Office

Electronic Health Records (EHR)

Job description

CareOregon is seeking a Registered Nurse in Utilization Management I to support UM program functions within the Clinical Operations department. The role focuses on Benefit Management, Benefit Review, Appeals and Grievances, and Health Related Services, with decisions based on clinical criteria while managing medical expenses.

Remote work with preference for Oregon/SW Washington. The position offers a competitive hiring range and 5% bonus target.