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Insurance Utilization Review Jobs in Tacoma, WA (NOW HIRING)

Centene

Remote Medical Director, Appeals

Auburn, WA · On-site +1

$236K - $449K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel ...

ScionHealth

Case Manager Part Time

Seattle, WA · On-site

$57.06 - $83.47/hr

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... Knowledge of Medicare benefits and insurance processes and contracts. * Knowledge of accreditation ...

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Insurance Utilization Review information

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$74

How much do insurance utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for insurance utilization review in Tacoma, WA is $45.41, according to ZipRecruiter salary data. Most workers in this role earn between $35.87 and $52.16 per hour, depending on experience, location, and employer.

What is an insurance utilization review?

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 key skills and qualifications needed to thrive in insurance utilization review?

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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Tacoma, WA?

The most popular types of Insurance Utilization Review jobs in Tacoma, WA are:

What are popular job titles related to Insurance Utilization Review jobs in Tacoma, WA?

For Insurance Utilization Review jobs in Tacoma, WA, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Tacoma, WA look for?

The top searched job categories for Insurance Utilization Review jobs in Tacoma, WA are:

What cities near Tacoma, WA are hiring for Insurance Utilization Review jobs?

Cities near Tacoma, WA with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Tacoma, WA as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution, with an average salary of $94,448 per year, or $45.4 per hour.

Utilization Review Nurse III - WA (UM/UR EXP HIGHLY PREF'D) NEEDED)

Kaiser Permanente

Renton, WA • On-site

$65.86/hr

Other

Posted 4 days ago

Kaiser Permanente rating

8.2

Company rating: 8.2 out of 10

Based on 927 frontline employees who took The Breakroom Quiz

55th of 898 rated healthcare providers

Job description

**  UTILIZATION REVIEW NURSE III  - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM **
**  PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED!  **
**  MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL CENTER  ** 
Job Summary:

In addition to the responsibilities listed below, this position is also responsible for applying advanced clinical and regulatory knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for moderately complex reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating and/or adjudicating referrals to appropriate services based on medical necessity.


Essential Responsibilities:
  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
  • Provides high-quality consultation by: facilitating and communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care; and leveraging comprehensive knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
  • Supports education and compliance initiatives by: remaining up-to-date and sharing information with the team on the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and supporting the development and delivery of education and training programs for staff and physicians at the local level to promote best practices in utilization management.
  • Assists in quality improvement efforts by: conducting standard data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing and refining desk-level procedures (e.g., workflows).
  • Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services; and assessing the ongoing need for services, proactively identifying, anticipating, and escalating potential issues/delays to internal team members, and recommending appropriate actions for moderately complex member cases.

Minimum Qualifications:


  • Bachelors Degree in Nursing AND minimum three (3) years of experience in direct patient care, utilization review/management, or discharge planning in a managed care setting or a directly related field.


  • Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire

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