Oregon Licensed Utilization Review Nurse

Job Summary

Evaluating clinical service requests, the full-time Oregon Licensed Utilization Review Nurse will conduct prior authorizations, facilitate care coordination, and ensure compliance with regulations while working remotely with occasional on-site travel as needed.

Key responsibilities

• Perform clinical assessments and prior authorizations to determine medical necessity
• Collaborate with interdisciplinary teams for care transitions and escalate complex cases as necessary
• Conduct audits and support quality improvement initiatives while maintaining compliance with organizational policies

Required qualifications

• 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 UM software
• No suspension, exclusion, or debarment from federal healthcare programs