Utilization Review Nurse

Innovative Care Management, Inc.; Portland (OR); Hybrid; USD 80,000 - 100,000; Full time

Job summary

Innovative Care Management, Inc. seeks a Utilization Review Nurse to lead training programs and ensure compliance in a remote role. This role requires expertise in nursing and collaboration on audits. Ideal candidates bring 5+ years of related experience and excellent communication skills.

Qualifications

• Minimum of 5 years nursing experience in managed care or utilization review.
• Experience developing and delivering clinical training is preferred.
• Comfort with technology platforms for clinical documentation.

Responsibilities

• Develop and deliver onboarding and training programs for new staff.
• Participate in audits of medical necessity reviews to ensure quality.
• Collaborate on interrater reliability assessments.

Skills

Excellent verbal communication

Critical thinking and clinical judgment

Detail-oriented

Proactive

Collaborative

Education

Bachelor’s degree in Nursing

Job description

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Innovative Care Management, Inc. provided pay range

This range is provided by Innovative Care Management, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$41.00/hr - $48.00/hr

The Utilization Review Nurse Trainer plays a vital role in onboarding and developing clinical staff to ensure high-quality, consistent, and compliant utilization review services. This position is responsible for designing and delivering training programs for new utilization review nurses, as well as providing ongoing education and support to current team members. The Utilization Review Nurse Trainer also collaborates with other clinical trainers to create standardized training materials that support clinical consistency across roles at ICM. In addition to leading training initiatives, the Utilization Review Nurse Trainer contributes to utilization review audits and interrater reliability (IRR) assessments to promote accuracy, quality, and alignment with internal policies, accreditation standards, and regulatory guidelines. This position enhances reviewer confidence, ensures peer alignment, and encourages a culture of continuous learning, which are essential elements in developing a high-performing clinical team.

This is a remote position; however, occasional in-office attendance may be required to deliver in-house training at our Portland, Oregon office. We are only considering candidates who reside in Oregon or Washington State.

Specific Position Requirements & Responsibilities:

Training and Onboarding:

• Develop and implement onboarding and training programs for new clinical staff in the utilization review process.
• Create and maintain utilization review clinical training materials, quick-reference guides, and job aids that reflect up-to-date policies, processes, and review criteria to reflect changes in workflows, tools, and compliance requirements
• Design utilization review and other clinical training content to support standardized workflows used by all clinical reviewers, ensuring clarity and consistency across the clinical teams.
• Collaborate with all trainers (clinical and non-clinical) to ensure consistency in approach and style across the organization.
• Deliver engaging, practical education using real-world examples and case studies.
• Design and deliver training for new processes, tools or platforms to ensure confident adoption and effective daily use.
• Adapts training to reflect evolving regulatory environments, including state-specific utilization review requirements and client-specific clinical policies.

Audit & Interrater Reliability (IRR)

• Participate in routine and targeted audits of medical necessity reviews to ensure quality, compliance, and appropriate clinical decision-making.
• Collaborate with the Compliance Officer to conduct interrater reliability assessments to ensure consistency among reviewers.
• Identify trends, gaps, or performance issues through audit and IRR results, and develop targeted training to address findings.
• Assists the compliance officer with tracking and reporting on training completion, clinical quality improvements, and IRR improvements over time.
• Support leadership in maintaining compliance with URAC standards and other applicable guidelines.
• Serve as a resource for clinical staff, offering guidance on accessing and interpreting clinical protocols, documentation practices, and decision-making frameworks.
• Collaborate with clinical leadership to identify training needs and support operational goals.
• Ensure consistency in training documentation across all clinical teams, including those supporting physician and chiropractic review.
• Promote a positive, engaged team culture that reflects ICM’s values of kindness, personal responsibility, humble confidence, and a can-do attitude.
• Contributes to clinical team engagement by supporting professional development, building confidence in decision-making, and promoting a shared understanding of clinical expectations.
• Other duties as assigned.

Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:

Required:

• Minimum of 5 years nursing experience in managed care, utilization review, case management, quality improvement, or acute care nursing—particularly roles involving interdisciplinary coordination, clinical documentation review, or patient discharge planning.
• Experience developing and delivering clinical training preferred; candidates without formal training experience may still be considered if they demonstrate strong clinical communication skills and a passion for developing others.”
• Comfort with technology platforms used for clinical documentation, utilization review, and virtual training delivery.
• Key competencies this position will require:
• Excellent verbal, written, and presentation skills.
• Strong critical thinking and clinical judgment.
• Detail-oriented, organized, and proactive.
• Collaborative and approachable, with a passion for developing others.
• Aligned with ICM’s culture of excellence, empathy, and continuous improvement.

Preferred:

• Experience working with self-funded ERISA health plans.
• Prior involvement in quality improvement, audits, or training development.
• Education or formal training in adult learning, instructional design, or staff development OR equivalent experience creating training materials in a clinical or healthcare setting.
• Strong understanding of medical necessity criteria, prior authorization processes, and relevant regulatory standards
• Familiarity with URAC requirements and utilization management best practices.

Education, Licensure, and Certification Requirements:

Required:

• Bachelor’s degree in Nursing, Health or Education related field .
• Active and unrestricted Registered Nurse (RN) license in good standing

Preferred:

• Additional certification in, healthcare management, or utilization review or case management (e.g., CCM, CPHM, CPUR).

Work and Physical Conditions:

• This is a remote role requiring a quiet, secure workspace with reliable internet. Occasional in-person attendance (1–2 times per quarter) may be needed for collaboration or training. The position involves long periods of computer work, frequent communication, and light physical activity (up to 15 lbs). All work must comply with HIPAA standards, and reasonable accommodations are available for individuals with disabilities to perform the essential functions of this job.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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