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Case Manager Utilization Review Nurse Jobs in Renton, WA

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

... nurse reviewer. * Reviews completed denial letters for accuracy and adherence to compliance ... The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to ...

The Emily Program

Case Manager

Seattle, WA · On-site

$25 - $30/hr

The case manager also facilitates the admission and discharge process, coordinates outpatient care ... Partner with the Utilization Review team to ensure that all necessary clinical documentation is ...

Santa Clara Post Acute

Case Manager RN

Tacoma, WA · On-site

$125K/yr

... coordination and utilization of services to ensure the highest quality care. Your key ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Case Manager Utilization Review Nurse information

See Renton, WA salary details

$21

$53

$90

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for case manager utilization review nurse in Renton, WA is $53.47, according to ZipRecruiter salary data. Most workers in this role earn between $39.76 and $64.62 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.
What are popular job titles related to Case Manager Utilization Review Nurse jobs in Renton, WA? For Case Manager Utilization Review Nurse jobs in Renton, WA, the most frequently searched job titles are:
What job categories do people searching Case Manager Utilization Review Nurse jobs in Renton, WA look for? The top searched job categories for Case Manager Utilization Review Nurse jobs in Renton, WA are:
What cities near Renton, WA are hiring for Case Manager Utilization Review Nurse jobs? Cities near Renton, WA with the most Case Manager Utilization Review Nurse job openings:
Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Renton, WA as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $111,210 per year, or $53.5 per hour.

Utilization Review Nurse

Virginia Mason Medical Center

Seattle, WA • On-site

$52.03 - $101.24/hr

Part-time

Posted 8 days ago

Job description


Job Summary and Responsibilities

As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and optimal patient outcomes. You will leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay.
Every day you will perform meticulous clinical assessments, identify and coordinate cost-effective alternatives, and proactively support provider decision-making. You will collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically, ensuring compliance with payer guidelines and regulatory standards.
To be successful in this role you will have strong analytical skills, persuasive communication, and a steadfast commitment to patient advocacy.  Fiscal stewardship is crucial for navigating complex clinical and financial landscapes, ensuring appropriate resource utilization.

Job Requirements

Required

  • Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
  • Active Washington State Registered Nurse License.
  • Experience in utilization review.
  • Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
  • An understanding of variable payor rules and regulations is also required.

Preferred

  • Knowledge of core insurance coverage guidelines and financial principles.
  • Acute care nursing experience.
Where You'll Work

Virginia Mason Franciscan Health brings together two award winning health systems in Washington state - CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers. At Virginia Mason Franciscan Health you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.

Qualifications:

Required

  • Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
  • Active Washington State Registered Nurse License.
  • Experience in utilization review.
  • Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
  • An understanding of variable payor rules and regulations is also required.

Preferred

  • Knowledge of core insurance coverage guidelines and financial principles.
  • Acute care nursing experience.
Employment Type: Part Time

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