Utilization Management Manager Health Plan

Clinical Management Consultants; Oregon; On-site; USD 120,000 - 150,000; Full time

Job summary

Clinical Management Consultants is seeking an experienced Health Plan Utilization Management RN Manager for the Portland Oregon Metro Area. This leadership role blends clinical judgment with operations, guiding utilization review processes and supporting nursing staff to ensure high-quality, cost-conscious care across multiple counties.

The ideal candidate has strong collaboration with medical directors, case management, and social work, excels at regulatory compliance, and can translate data

Qualifications

• Active RN license in Oregon.
• Experience in utilization management or UR/UM.
• Strong leadership and people management skills.
• Ability to collaborate with medical directors and care teams.

Responsibilities

• Lead UR/UM operations and staff.
• Coordinate review workflows and documentation.
• Monitor timeliness and quality of reviews.
• Partner with medical directors, clinicians, case management and social work.

Skills

Nursing leadership

Clinical judgment

Utilization review

Regulatory compliance

Collaborative/team leadership

Education

BSN

Nurse Manager Certification

Tools

EHR systems

Case management software

Regulatory reporting tools

Job description

Bring your hospital-honed clinical judgment to the Health Plan Utilization Management RN Manager opportunity in the Portland Oregon Metro Area—a meaningful next step for 2026 that connects patient advocacy, leadership growth, and community impact with the pursuit of supportive leadership, clinician-friendly technology, and Pacific Northwest quality of life.

For an experienced nurse exploring healthcare leadership jobs beyond the bedside, this Health Plan Utilization Management RN Manager role offers a compelling connection between clinical decisions and access to care. This healthcare organization is a well-regarded local health plan with community programs and a multi-county reach. Its community-centered setting gives utilization management leadership a purpose that extends beyond individual reviews: helping members navigate appropriate services while strengthening relationships with the hospitals and clinicians delivering their care.

Within UM, the Health Plan Utilization Management RN Manager opportunity brings together insurance-based utilization review, clinical reasoning, and care coordination across a varied membership. The population includes Medicare members as well as pediatric and adult patients, creating exposure to different care needs and transitions between settings. Several community programs and coverage across multiple counties add an important local dimension to Utilization Management. For a nurse ready to expand beyond a single hospital department, this environment connects individual medical-necessity decisions with broader questions of access, continuity, and responsible resource use.

The Insurance UR/UM Manager role centers on guiding clinical review operations, supporting nursing staff, and strengthening consistent, evidence-based decision-making. Relevant responsibilities include coordinating review workflows, monitoring timeliness and documentation quality, supporting regulatory compliance, and identifying opportunities for performance improvement. Collaboration with medical directors, treating clinicians, case management, and social work helps clarify clinical information and resolve barriers to appropriate care. The specific reporting relationship and team structure should be confirmed during the interview process. At its best, this work pairs clear escalation pathways with technology that supports-not replaces- professional nursing judgment.

For an RN with utilization review experience and a foundation in medical necessity, the Health Plan Utilization Management RN Manager position represents a move toward broader operational influence. Developing staff, improving review consistency, and translating clinical trends into practical workflow changes can build expertise relevant to future healthcare management roles. Professionals comparing nursing jobs and hospital careers in 2026 should also explore leadership mentoring, continuing education, workload expectations, staffing resources, and schedule structure during recruiter conversations. These details help distinguish a meaningful advancement opportunity from a change in title alone.

The Portland Oregon Metro Area adds a distinctive lifestyle dimension to the Health Plan Utilization Management RN Manager opportunity. Forest Park trails, neighborhood coffee shops, a celebrated food scene, and access to the Columbia River Gorge create appealing ways to recharge outside work. Mount Hood and the Oregon Coast offer memorable weekend destinations, while Portland International Airport supports travel farther afield. Housing costs and commute times vary considerably across the metro area, making neighborhood choice an important part of planning a move. For healthcare professionals seeking urban amenities with access to nature, the region offers a compelling balance.

A competitive compensation arrangement and comprehensive benefits package are important parts of evaluating the Health Plan Utilization Management RN Manager opportunity. Ask about the current salary range, available benefits, time-off provisions, retirement options, and professional development support so the complete offering can be assessed against your priorities.