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Insurance Utilization Review Jobs in Seattle, WA

CommonSpirit Health

Utilization Review Nurse

Seattle, WA · On-site

As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care ... Knowledge of core insurance coverage guidelines and financial principles. * Acute care nursing ...

New

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

Wage Range: $28.83 - $46.14 per hour 5 years of experience in denial management, utilization review ... Medical, vision and dental insurance * On-demand virtual health care * Health Savings Account

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

Wage Range: $28.83 - $46.14 per hour 5 years of experience in denial management, utilization review ... Medical, vision and dental insurance * On-demand virtual health care * Health Savings Account

EvergreenHealth

Denial Management Specialist

Kirkland, WA · On-site

$28.83 - $46.14/hr

... utilization review or prior authorization in a hospital, provider, or healthcare system. Healthcare ... Medical, vision and dental insurance * On-demand virtual health care * Health Savings Account

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Seattle, WA

Insurance Utilization Review information

See Seattle, WA salary details

$24

$48

$78

How much do insurance utilization review jobs pay per hour?

As of Jul 30, 2026, the average hourly pay for insurance utilization review in Seattle, WA is $48.12, according to ZipRecruiter salary data. Most workers in this role earn between $38.03 and $55.24 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Seattle, WA? The most popular types of Insurance Utilization Review jobs in Seattle, WA are:
What are popular job titles related to Insurance Utilization Review jobs in Seattle, WA? For Insurance Utilization Review jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Seattle, WA look for? The top searched job categories for Insurance Utilization Review jobs in Seattle, WA are:
What cities near Seattle, WA are hiring for Insurance Utilization Review jobs? Cities near Seattle, WA with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Seattle, WA as of July 2026, with employment types broken down into 1% As Needed, 69% Full Time, 24% Part Time, 1% Temporary, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $100,084 per year, or $48.1 per hour.

Utilization Review Nurse

Virginia Mason Medical Center

Seattle, WA

$52.03 - $101.24/hr

Part-time

Posted 3 days ago

New

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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